Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
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DOI：
10.1017/s0266462307070365
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发表时间：
2007-03-01
影响因子：
3.2
通讯作者：
Ford, Richard J.
中科院分区：
文献类型：
--
作者：
Girling, Alan J.;Freeman, Guy;Ford, Richard J.
目的：设计的不断发展改善了左心室辅助装置（LVAD）植入治疗终末期心力衰竭的前景。然而，基于第一代设备的早期成本效益评估并不令人鼓舞。在此背景下，我们着手 (i) 研究 LVAD 需要产生的生存效益，然后才能被认为具有成本效益； (ii) 深入了解实现这一效益的可能性； (iii) 从医疗保健提供者的角度来看，通过贝叶斯信息分析值来评估发现这种益处的实际大小的价值。方法：成本效益评估是从医疗保健提供者的角度进行的，使用英国现行的质量调整生命年 (QALY) 值标准。该治疗模型以已发表的第一代 LVAD 机械辅助治疗充血性心力衰竭 (REMATCH) 试验的分析为基础，并转化为英国的成本设置。使用贝叶斯先验分布对第二代配给设备的患者生存前景进行评估，该先验分布来自该领域的一组领先临床医生。结果：使用既定阈值，发现对于成本高达 60,000 英镑的设备，在这些先验条件下的成本效益概率很低（类似于 2%）。检查结论对设备成本和 QALY 评估的敏感性。结论：如果使用中的设备的价格降至 40,000 英镑，则生存信息的价值可以很容易证明对进一步试验的投资是合理的。
Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis.Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-gene ration devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field.Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (similar to.2 percent) for devices costing as much as 60,000 pound. Sensitivity of the conclusions to both device cost and QALY valuation is examined.Conclusions: In the event that the price of the device in use would reduce to 40,000 pound, the value of the survival information can readily justify investment in further trials.