Cost-effectiveness analysis of ventricular assist device and heart transplantation in the treatment of end-stage heart failure

The aim of this study was to determine the cost-effectiveness of heart transplantation (HTx) and left ventricular assist device (LVAD) treatment modalities for end-stage heart failure from the perspective of SSI, the reimbursement institution, and to estimate the budget impact of these treatment modalities. Within the scope of the research, cost data were obtained by Delphi Panel method and effectiveness data were obtained from the literature by systematic review. Within the scope of the Delphi Panel method, a cost form was created with a group of 11 experts working in multidisciplinary fields. Effectiveness data were obtained through a systematic review. In the study, the cost-effectiveness of treatment options was calculated with the Markov model. In the study, the model cycle lengths were run monthly and the time period was taken as lifetime (10 years). The clinical effectiveness of treatment options in the study was calculated using quality-adjusted life years (QALYs). The reduction rate was taken as 3%. The results were determined by Additional Cost Effectiveness Ratio (ICER) and additional net monetary benefit (NMB) measures. One-way and probabilistic sensitivity analyses (PSA) were also performed. According to the findings of the study, the total cost of HTx was 2.250.974 TL/69.840 $ in 10 years, of which 55,5% was operation cost and 44,5% was drug and follow-up cost. The total cost of LVAD treatment was 3.000.956 TL/93.110 $, of which 62,8% was operation and device cost and 37,2% was medication and follow-up cost. While the QALY value of HTx treatment option was 8.39, the QALY value of LVAD treatment was 7.39. As a result of the cost-effectiveness analysis, heart transplantation provided an additional gain of 0.99 QALY and 753.432 TL/$23,376-$ compared to LVAD. According to the results of the budget impact analysis, it was determined that heart transplantation treatment costs accounted for 0.01% of total health expenditures in 2024. In this study, HTx was found to be a cost-effective treatment option compared to LVAD in the treatment of end-stage heart failure. However, HTx patients may die during the waiting period for a donor heart or may not be eligible for transplantation due to deteriorating clinical condition. For these patients, LVAD therapy is used as a bridge to HTx therapy or as an alternative therapy to HTx. Therefore, each of the two treatment modalities is a life-saving intervention. In the treatment of end-stage heart failure, these treatment modalities should be considered as complementary rather than competitive. In addition, since it is not possible to perform heart transplantation in all patients with end-stage heart failure, it is recommended to develop health policies to reduce the cost of the device in order to increase the cost-effectiveness of the LVAD method. In case the clinical efficacy findings of LVAD device technology in the treatment of end-stage heart failure improve and its cost decreases, the cost-effectiveness of these treatments should be re-analysed. Key Words: Heart Failure, LVAD, Heart Transplant, Cost Effectiveness Analysis