The Artificial Heart Prototypes, Policies, and Patients (1991) / Chapter Skim
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6. Cost-Effectiveness Analysis
6. Cost-Effectiveness Analysis
Pages 107-120
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From page 107... ...
This chapter considers the projected treatment cost-effectiveness of total artificial hearts (TAHs) and also illustrates a way in which CEA can assist in making decisions about the level of research on a particular technology.
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From page 108... ...
The discount rate attempts to adjust for the fact that a dollar not spent today would earn interest, which could then be made available for future health programs. For long-term projections, low discount rates tend to favor projects whose benefits accrue in the distant future or whose major costs occur in the near term.
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From page 109... ...
~ ~~ A _~ ~4 _~— ~4 _ ~~~ ~Jll~_l~~ art VY 11. COST-EFFECTIVENESS OF TOTAL ARTIFICIAL HEARTS The CEA performed for this committee provides a means of comparing the anticipated clinical benefits and costs of using a TAH with those of other forms of heart disease treatment as well as treatments for other diseases.
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From page 110... ...
The cost-utility data assessing the quality of life under the various health states are the group opinions of the committee, not of actual or prospective TABLE 6.1 Utility Values for End-Stage Heart Disease States by Time Trade-off Method Mean Utility Patient Group/ Long-Term In Regular In Health State Health State Hospital Bed ICU/CCU Medical treatment 0.08 0.01 -0.11 only (moribund) TAH recipient 0.66 0.52 0.40 Heart transplant 0.75 0.55 0.42 ICU/CCU, intensive care unit/coronary care unit; TAH, total artificial heart.
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From page 111... ...
Results of the CEA are thus presented both with and without incorporating these data, that is, both unadjusted and adjusted for the quality-of-life utility values. Table 6.2B, comparing both TAH use and heart transplantation with conventional medical treatment, shows that a TAH yields an average increase of 2.85 years in quality-adjusted life expectancy at a net cost of $299,000, for a C/E ratio of $105,000 per QALY gained.
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From page 112... ...
Other applications of some of these interventions have even higher C/E ratios, for instance, coronary artery bypass surgery for very mild angina or care of a low-risk patient in a coronary care unit instead of an intermediate care unit. Such interventions with low-risk patients are generally deemed inappropriate, although they sometimes occur.
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From page 113... ...
intermediate care) High risk Low risk Mobile Coronary Care Units Percutaneous Transluminal Coronary Angioplasty Severe angina Mild angina Automatic Implantable Cardioverter Defibrillator (AICD)
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From page 114... ...
Cost-Effectiveness of Ventricular Assist Devices The primary charge of the committee was to make recommendations about NHLBI's future support for TAH development and the CEA thus focused on that device. CEA can, of course, be applied to a ventricular assist device (VAD)
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From page 115... ...
As explained in more detail in Appendix E, TAH developers advised the committee that increased funding levels of TAH development during the l990s would likely yield long-term benefits, because the additional funding would allow earlier completion of R&D, making devices available for use sooner and thereby extending the lives of some patients who would otherwise die. The added funding would also perhaps reduce the selling price because of resulting design improvements and thus create long-term savings in health care costs, with the TAH selling price lowered from about $100,000 to $70,000 or $78,50O, depending on the scenario.
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From page 116... ...
It also provides a specific method that the NHLI3I can use to help in deciding issues that it must face in the l990s about continuing to support TAH development and, if so, at what dollar level. CONCLUSIONS The Borderline Cost-Effectiveness of Artificial Heart Use The CEA performed for the committee reveals that the estimated benefits from using a long-term TAH compared with medical treatment yield a C/E ratio ($105,000 per QALY gained)
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From page 117... ...
Using Cost-Effectiveness to Decide Funding Levels Applying CEA to a narrowly defined question about a single R&D program allows the long-term effects of such options as alternative funding levels to be examined, in addition to CEA's broader R&D fundingallocation use discussed in Chapter 3. Subject to validation of the underlying assumptions, this portion of the committee's CEA shows that NHLBI may wish to increase its level of investment in the next full-scale phase of TAH development because of the benefits that may be derived, in life years gained, from earlier device availability.
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From page 118... ...
1990. Myocardial revascularization for chronic stable angina: Analysis of the role of percutaneous transluminal coronary angioplasty based on data available in 1989.
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From page 119... ...
. pnyslca1 actlvltles None Some anxiety about MCSS failure risk; not depressed Generally positive, with realistic concern about device or battery failure Same as Premorbid state Premorbid normal, except for constant need for available backup power source Able to perform all Premorbid normal Able to return to preillness activity None except dur.
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From page 120... ...
Depressed and anxious Good state of mind; Good state of because prognosis is considerable anxiety poor about long-term outcome Only closest relatives Close relatives and friends Severe C: Regular Hospitalization (not ICU/CCU) Some anxiety about recurrence of problem Regular visits from relatives mind; mild anxiety about recovery and future Closest relatives and friends Severe Good state of mind; some anxiety about future problems Many visits and telephone calls Some anxiety about recurrence of problem Frequent visits and friends Discomfort Moderate Occasional Occasional MCSS, mechanical circulatory support system; LE, life expectancy; Tx, transplant; ICU/ CCU, intensive care unit/coronary care unit
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