Cost-effectiveness of left ventricular assist devices for patients with end-stage heart failure: analysis of the French hospital discharge database

ESC Heart Fail. 2018 Feb;5(1):75-86. doi: 10.1002/ehf2.12194. Epub 2017 Jul 25.


Aims: Although left ventricular assist devices (LVADs) are currently approved for coverage and reimbursement in France, no French cost-effectiveness (CE) data are available to support this decision. This study aimed at estimating the CE of LVAD compared with medical management in the French health system.

Methods and results: Individual patient data from the 'French hospital discharge database' (Medicalization of information systems program) were analysed using Kaplan-Meier method. Outcomes were time to death, time to heart transplantation (HTx), and time to death after HTx. A micro-costing method was used to calculate the monthly costs extracted from the Program for the Medicalization of Information Systems. A multistate Markov monthly cycle model was developed to assess CE. The analysis over a lifetime horizon was performed from the perspective of the French healthcare payer; discount rates were 4%. Probabilistic and deterministic sensitivity analyses were performed. Outcomes were quality-adjusted life years (QALYs) and incremental CE ratio (ICER). Mean QALY for an LVAD patient was 1.5 at a lifetime cost of €190 739, delivering a probabilistic ICER of €125 580/QALY [95% confidence interval: 105 587 to 150 314]. The sensitivity analysis showed that the ICER was mainly sensitive to two factors: (i) the high acquisition cost of the device and (ii) the device performance in terms of patient survival.

Conclusions: Our economic evaluation showed that the use of LVAD in patients with end-stage heart failure yields greater benefit in terms of survival than medical management at an extra lifetime cost exceeding the €100 000/QALY. Technological advances and device costs reduction shall hence lead to an improvement in overall CE.

Keywords: Cost-effectiveness; Costs; Incremental cost-effectiveness ratio; Left ventricular assist devices; PMSI.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Heart Failure / economics
  • Heart Failure / epidemiology
  • Heart Failure / surgery*
  • Heart-Assist Devices / economics*
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Patient Discharge / statistics & numerical data*
  • Prevalence
  • Quality of Life
  • Retrospective Studies
  • Young Adult