Bart S. Ferket, MD, PhD, Jonathan M

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Presentation transcript:

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies Bart S. Ferket, MD, PhD, Jonathan M. Oxman, BA, Alexander Iribarne, MD, MS, Annetine C. Gelijns, PhD, Alan J. Moskowitz, MD, FACP The Journal of Thoracic and Cardiovascular Surgery Volume 155, Issue 4, Pages 1671-1681.e11 (April 2018) DOI: 10.1016/j.jtcvs.2017.11.018 Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Cost-effectiveness analyses in cardiac surgery published since January 2000. LVAD, Left ventricular assist device; DT, destination therapy; DES, drug-eluting stent; TAVR, transcatheter aortic valve replacement; CF, continuous-flow; BTT, bridge to transplant; ACA, Affordable Care Act; AS, aortic stenosis; CEA, cost-effectiveness analysis; FDA, Food and Drug Administration; MR, mitral regurgitation; HF, heart failure. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Hypothetical individual patient's follow-up duration adjusted for quality of life. The patient's health state is longitudinally measured via a health state classification instrument at preoperative and several postoperative time points. The health states are then converted into utilities using HRQoL weights based on societal preferences. QALYs are represented by the area under the curve, ie, the sum of each period multiplied by the HRQoL/utility during that period. Zero indicates death, whereas 1 indicates perfect health. HRQoL, Health-related quality-of-life; QALY, quality-adjusted life year. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Hypothetical PSA plotted on a cost-effectiveness plane. When 2 competing surgeries are compared, surgery A versus B, a scatterplot of the difference in average costs and QALYs per PSA iteration can be created with a diagonal representing the cost-effectiveness threshold. The percentage of points lying to the right of a given threshold line indicates the probability that the intervention is cost-effective relative to the competing intervention. Multiple cost-effectiveness thresholds can be plotted to determine the impact on the probability of cost-effectiveness. The lower right quadrant represents iterations in which the intervention A is “dominant” due to having lower incremental costs and greater incremental QALYs than B. The upper left quadrant represents iterations where A is “dominated” due to greater incremental costs and lower incremental QALYs. The upper right and lower left quadrants represent tradeoffs between greater and lower incremental costs and QALYs, respectively. QALY, Quality-adjusted life year. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Cost-effectiveness acceptability curves. This graph shows the probability of each intervention being cost-effective given a range for society's willingness to pay to gain 1 QALY. As the cost-effectiveness threshold increases, the probability that surgery A is cost-effective increases while that of B decreases (equal to 100% − probability A is cost-effective). The vertical lines represent just 2 of the cost-effectiveness thresholds and correspond directly to the diagonals on the cost-effectiveness plane. QALY, Quality-adjusted life year. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 One-way deterministic sensitivity analyses across several model inputs. The base case scenario represents the ICER point estimate when comparing 2 surgeries. In deterministic sensitivity analysis, a given input, eg, the HRQoL weight, is varied in the model to determine how upper and lower bound assumptions impact outcomes. For example, when comparing surgery A versus B, assuming a greater HRQoL after A lowers the ICER, as incremental QALYs increase. HRQoL, Health-related quality-of-life; QALY, quality-adjusted life year. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study inclusion. CEA, Cost-effectiveness analysis. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Publication trends in cardiac surgery cost-effectiveness analysis since January 2000. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Key concepts and methodologies of cost-effectiveness analysis in cardiac surgery. Video available at: http://www.jtcvsonline.org/article/S0022-5223(17)32690-9/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 155, 1671-1681.e11DOI: (10.1016/j.jtcvs.2017.11.018) Copyright © 2017 The American Association for Thoracic Surgery Terms and Conditions