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Article: Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy

TitleModeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
Authors
Issue Date2007
PublisherCambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=THC
Citation
International Journal of Technology Assessment in Health Care, 2007, v. 23 n. 2, p. 269-277 How to Cite?
AbstractOBJECTIVES: 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-generation 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 (approximately .2 percent) for devices costing as much as 60,000 pounds. 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 pounds, the value of the survival information can readily justify investment in further trials.
Persistent Identifierhttp://hdl.handle.net/10722/176514
ISSN
2015 Impact Factor: 1.03
2015 SCImago Journal Rankings: 0.854
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorGirling, AJ-
dc.contributor.authorFreeman, G-
dc.contributor.authorGordon, JP-
dc.contributor.authorPoole-Wilson, P-
dc.contributor.authorScott, DA-
dc.contributor.authorLilford, RJ-
dc.date.accessioned2012-11-30T07:11:00Z-
dc.date.available2012-11-30T07:11:00Z-
dc.date.issued2007-
dc.identifier.citationInternational Journal of Technology Assessment in Health Care, 2007, v. 23 n. 2, p. 269-277-
dc.identifier.issn0266-4623-
dc.identifier.urihttp://hdl.handle.net/10722/176514-
dc.description.abstractOBJECTIVES: 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-generation 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 (approximately .2 percent) for devices costing as much as 60,000 pounds. 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 pounds, the value of the survival information can readily justify investment in further trials.-
dc.languageeng-
dc.publisherCambridge University Press. The Journal's web site is located at http://journals.cambridge.org/action/displayJournal?jid=THC-
dc.relation.ispartofInternational Journal of Technology Assessment in Health Care-
dc.rightsInternational Journal of Technology Assessment in Health Care. Copyright © Cambridge University Press.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshCost-Benefit Analysis-
dc.subject.meshModels, Theoretical-
dc.subject.meshResearch-
dc.subject.meshSelf-Help Devices-
dc.subject.meshVentricular Dysfunction, Left-
dc.titleModeling payback from research into the efficacy of left-ventricular assist devices as destination therapyen_US
dc.typeArticleen_US
dc.identifier.emailFreeman, G: gfreeman@hku.hk-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1017/S0266462307070365-
dc.identifier.pmid17493314-
dc.identifier.scopuseid_2-s2.0-34247353338-
dc.identifier.volume23-
dc.identifier.issue2-
dc.identifier.spage269-
dc.identifier.epage277-
dc.identifier.isiWOS:000245840700015-
dc.publisher.placeUnited Kingdom-

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