Cost-effectiveness analysis of bridge-to-transplantation temporary mechanical circulatory support versus non-bridged heart transplantation

TL;DR

This study compares the cost-effectiveness of temporary mechanical circulatory support before heart transplant versus direct transplant in Chinese patients.

Contribution

The study evaluates the cost-effectiveness of BTT-tMCS therapy for heart transplantation in the Chinese population.

Findings

BTT-tMCS therapy had higher lifetime costs but also higher quality-adjusted life-years compared to nonbridged HTx.

The incremental cost-effectiveness ratio was 28,966.88 RMB per QALY, showing potential cost-effectiveness.

Sensitivity analyses confirmed the robustness of the cost-effectiveness results.

Abstract

Among patients undergoing heart transplantation, BTT-tMCS therapy demonstrates superior clinical efficacy compared to nonbridged HTx; however, its cost-effectiveness among Chinese patients remain uncertain. To evaluate the cost-effectiveness of BTT-tMCS therapy compared with nonbridged HTx among transplant-eligible Chinese patients from the healthcare payer’s perspective.

The cost-effectiveness analysis for this economic evaluation was conducted at a qualified heart transplantation center in Central China. Participants included patients admitted since 2018 who underwent either BTT-tMCS or nonbridged HTx, identified retrospectively from local electronic medical records and supplemented by corresponding questionnaires. Propensity score matching (PSM) was employed to obtain a homogeneous group of HTx patients to generate model input parameters. A Markov model simulates lifetime disease progression and associated costs for HTx patients, with monetary values standardized to 2023. Sensitivity analyses were performed to test the internal validity of the model’s conclusions. The model evaluated two competing treatment strategies: BTT-tMCS and standard care. Lifetime health care cost and quality-adjusted life-years (QALYs) of the simulated cohort.

PSM identified 40 matched subjects who met the predefined criteria, creating a homogeneous cohort for analysis. Compared to nonbridged HTx, BTT-tMCS yielded higher lifetime incremental costs (510,361 RMB) and effects (5.88 QALYs), resulting in an ICER of 28966.88 RMB/QALY. Sensitivity analyses demonstrated the robustness of these findings, with a 90% probability of cost-effectiveness achieved at a willingness-to-pay threshold exceeding 80422.20 RMB/QALY.

In this economic evaluation study, BTT-tMCS therapy was more likely to be cost-effective compared with non-bridged HTx.

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