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Pediatric Cardiology

, Volume 39, Issue 6, pp 1242–1248 | Cite as

Cost-Effectiveness of Ventricular Assist Device Destination Therapy for Advanced Heart Failure in Duchenne Muscular Dystrophy

  • Defne A. Magnetta
  • JaHyun Kang
  • Peter D. Wearden
  • Kenneth J. Smith
  • Brian Feingold
Original Article
  • 141 Downloads

Abstract

Destination ventricular assist device therapy (DT-VAD) is well accepted in select adults with medically refractory heart failure (HF) who are not transplant candidates; however, its use in younger patients with progressive diseases is unclear. We sought to evaluate the cost-effectiveness of DT-VAD in Duchenne muscular dystrophy (DMD) patients with advanced HF. We created a Markov-state transition model (5-year horizon) to compare survival, costs, and quality of life (QOL) between medical management and DT-VAD in DMD with advanced HF. Model input parameters were derived from the literature. We used sensitivity analyses to explore uncertainty around model assumptions. DT-VAD had higher costs ($435,602 vs. $125,696), survival (3.13 vs. 0.60 years), and quality-adjusted survival (1.99 vs. 0.26 years) than medical management. The incremental cost-effectiveness ratio (ICER) for DT-VAD was $179,086 per quality-adjusted life year (QALY). In sensitivity analyses that were widely varied to account for uncertainty in model assumptions, the DT-VAD strategy generally remained more costly and effective than medical management. Only when VAD implantation costs were <$113,142 did the DT-VAD strategy fall below the $100,000/QALY willingness-to-pay threshold commonly considered to be “cost-effective.” In this exploratory analysis, DT-VAD for patients with DMD and advanced HF exceeded societal expectations for cost-effectiveness but had an ICER similar to the accepted practice of DT-VAD in adult HF patients. While more experience and research in this population is needed, our analysis suggests that DT-VAD for advanced HF in DMD should not be dismissed solely based on cost.

Keywords

Mechanical circulatory support Heart failure Cardiomyopathy Neuromuscular disease Quality of life Cost effectiveness 

Notes

Compliance with Ethical Standards

Conflict of interest

Defne Magnetta, JaHyun Kang, Peter Wearden, Kenneth Smith, and Brian Feingold declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Defne A. Magnetta
    • 1
  • JaHyun Kang
    • 2
    • 3
  • Peter D. Wearden
    • 4
  • Kenneth J. Smith
    • 5
  • Brian Feingold
    • 1
    • 6
  1. 1.PediatricsChildren’s Hospital of PittsburghPittsburghUSA
  2. 2.College of NursingSeoul National UniversitySeoulSouth Korea
  3. 3.Research Institute of Nursing ScienceSeoul National UniversitySeoulSouth Korea
  4. 4.Cardiothoracic SurgeryNemours Children’s HospitalOrlandoUSA
  5. 5.Section of Decision Sciences, Department of MedicineUniversity of PittsburghPittsburghUSA
  6. 6.Clinical and Translational ResearchUniversity of PittsburghPittsburghUSA

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