Search

Supplemental Digital Content is available in the text.There is limited data on the cost-effectiveness of continuous-flow left ventricular assist devices (LVAD) in the United States particularly for the bridge-to-transplant indication. Our objective is to study the cost-effectiveness of a small intrapericardial centrifugal LVAD compared with medical management (MM) and subsequent heart transplantation using the respective clinical trial data. We developed a Markov economic framework. Clinical inputs for the LVAD arm were based on prospective trials employing the HeartWare centrifugal-flow ventricular assist device system. To better assess survival in the MM arm, and in the absence of contemporary trials randomizing patients to LVAD and MM, estimates from the Seattle Heart Failure Model were used. Costs inputs were calculated based on Medicare claim analyses and when appropriate prior published literature. Time horizon was lifetime. Costs and benefits were appropriately discounted at 3% per year. The deterministic cost-effectiveness analyses resulted in $69,768 per Quality Adjusted Life Year and $56,538 per Life Year for the bridge-to-transplant indication and $102,587 per Quality Adjusted Life Year and $87,327 per Life Year for destination therapy. These outcomes signify a substantial improvement compared with prior studies and re-open the discussion around the cost-effectiveness of LVADs.

Supplemental Digital Content is available in the text.This study reports the first analysis regarding cost-effectiveness of left ventricular assist device (LVAD) implantation viathoracotomy. Cost-effectiveness of LVADs implanted viathe traditional surgical approach of sternotomy has been improved through the years because of technological advances, along with understanding the importance of patient selection and postimplant management have on positively affecting outcomes. Given the positive clinical outcomes of the thoracotomy approach, we seek to study the cost-effectiveness of a centrifugal LVAD viathis less invasive approach. We developed a Markov model. Survival and quality of life inputs (QALY) for the LVAD arm were based on data from the LATERAL clinical trial. For the Medical Management arm, survival was derived from the Seattle Heart Failure Model. The heart transplant probability was derived from INTERMACS. Survival after heart transplantation used International Society for Heart and Lung Transplantation data. Cost inputs were calculated based on Medicare data and past literature. The incremental cost-effectiveness ratio was found to be $64,632 per quality adjusted life year and $57,891 per life year in the bridge to transplant indication. These results demonstrate further improvement in the overall cost-effectiveness of LVAD therapy and confirm implantation of LVADs viaa less invasive approach as being cost-effective.

AbstractAims:Heart failure with reduced ejection fraction (HFrEF) has a substantial impact on costs and patients’ quality-of-life. This study aimed to estimate the cost-effectiveness of implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy pacemakers (CRT-P), cardiac resynchronization therapy defibrillators (CRT-D), and optimal pharmacologic therapy (OPT) in patients with HFrEF, from a US payer perspective.Materials and methods:The analyses were conducted by adapting the UK-based cost-effectiveness analyses (CEA) to the US payer perspective by incorporating real world evidence (RWE) on baseline hospitalization risk and Medicare-specific costs. The CEA was based on regression equations estimated from data from 13 randomized clinical trials (n = 12,638). Risk equations were used to predict all-cause mortality, hospitalization rates, health-related quality-of-life, and device-specific treatment effects (vs. OPT). These equations included the following prognostic characteristics: age, QRS duration, New York Heart Association (NYHA) class, ischemic etiology, and left bundle branch block (LBBB). Baseline hospitalization rates were calibrated based on RWE from Truven Health Analytics MarketScan data (2009–2014). A US payer perspective, lifetime time horizon, and 3% discount rates for costs and outcomes were used. Benefits were expressed as quality-adjusted life-years (QALYs). Incremental cost-effectiveness analysis was conducted for 24 sub-groups based on LBBB status, QRS duration, and NYHA class.Results:Results of the analyses show that CRT-D was the most cost-effective treatment at a $100,000/QALY threshold in 14 of the 16 sub-groups for which it is indicated. Results were most sensitive to changes in estimates of hospitalization costs.Limitations:Study limitations include small sample sizes for NYHA I and IV sub-groups and lack of data availability for duration of treatment effect.Conclusions:CRT-D has higher greater cost-effectiveness across more sub-groups in the indicated patient populations against as compared to OPT, ICD, and CRT-P, from a US payer perspective.

Aim:To date, no studies have used a commercially available claims dataset to examine the characteristics, conditions, and healthcare service utilization of individuals with Rett syndrome. Objective:To improve understanding of the Rett population using data available to health insurance plans. Methods:Data were integrated medical and pharmacy claims from the Real-World Evidence data repository licensed from the Decision Resources Group. Individuals had claims for >2 visits which included a diagnosis of Rett and were stratified into three age groups: 1 (<5 years), 2 (>5 and <10 years) and 3 (>10 years). Co-occurring conditions and healthcare service utilization were measured. Diagnoses prior to Rett were evaluated. Results:Most were female. Epilepsy, incontinence, and scoliosis were common co-occurring conditions. Individuals averaged 4.6 office and 2.5 outpatient visits, and 2.1 emergency and 2.9 inpatient admissions. Group 1 used more physical, occupational and speech therapy and averaged more inpatient days compared with others (p < 0.05). Conclusion:This study improves understanding of Rett using data that is typically available to health insurance companies.

Background:Though rarely diagnosed with Rett syndrome, males account for 3–5% of all cases in the USA. Nevertheless, few studies have examined characteristics of males with Rett syndrome and their healthcare service utilization using commercially available healthcare claims data. Objective:Improve understanding of healthcare service utilization and cost associated with the population of males with Rett syndrome. Methods:Data were integrated medical and pharmacy claims. Male individuals with more than two claims with a primary diagnosis of Rett syndrome were stratified into age groups (<5 years; ≥5 and <10 years; and ≥10 years). Patient descriptions, comorbidities, service utilization and cost were measured. Results:Mean age was 20.4 years and most patients had Medicaid. Epilepsy, incontinence, dyspnea and dysphagia were common comorbidities during follow-up. Individuals averaged 6.7 office visits, 4.1 outpatient visits, 2.2 emergency admissions and 4.5 inpatient admissions per year. Occupational therapy was used more than physical and speech therapy. Conclusion:The study improves understanding of males with Rett syndrome within a commercially available dataset.

The article discusses the opportunities presented by the healthcare reform to optometrists and how the coming changes will affect the practice of optometry. It refers to the Affordable Care Act as the most far-reaching change in healthcare that is aimed at increasing coverage, improving health status and lowering system costs. It notes how optometry can help on the primary issues ACA is focused on such as access for patients with impeded access, efficiency and reforming reimbursement streams.