Assessment of the Business Case for Left Ventricular Assist DevicesNational Service & Technology Review Advisory Committee (NSTR)
Date of publication: November 2008
Context
The National Service and Technology Review Advisory Committee (NSTR) considered the left ventricular assist device (LVAD) – as a bridge to heart transplantation business case in the context of the following.
- The current heart transplant budget received by ADHB is $2,187,095 which funds on average 11 transplants and the service has allowed for two LVADs – per annum.
- The proposal recommends that the total of $2,187,095 be INCREASED to fund another two LVADs per annum, i.e. a total of four per annum. On ADHB costings, this equates to another $248,000 per annum, being $124,000 per patient receiving an LVAD (inclusive of $83,000 for the device). NSTR has recommended this should be ‘new’ funding.
- The Ministry of Health has advised NSTR that the additional funding could come from the National Services Top Slice.
- A national heart transplant waiting list of typically 10–12 but as low as 4–5.
- A national heart transplant programme funded for 14–15.
- Extreme variability in donor organ availability.
- Ongoing donor organ shortage could potentially convert approval for “LVAD bridge to transplant” into “LVAD destination”.
- To be successful an LVAD service will require an improvement to the supply of donor organs.
Recommendations
The National Service and Technology Review Advisory Committee (NSTR) recommends that the Ministry’s Executive Leadership Team and the DHB CEOs note that:
1. Left ventricular assist devices (LVADs) are an emergent technology.
2. LVAD implantation has been undertaken in New Zealand as part of a clinical trial and that the clinical skills required to undertake the procedure already exist in New Zealand.
3. The estimated cost of this procedure is $124,000 per implantation (including $83,500 for the device).
4. The possibility exists that increasing the demand for heart transplants by implanting LVADs may, in the face of limited organ availability, crowd out other patients requiring transplants and decrease the overall transplant survival rate.
5. NSTR and the business case support an “LVAD as a bridge to transplant” service as intention to treat, and do not support an LVAD service should that service become a “destination”.
NSTR recommends that the Ministry’s Executive Leadership Team and the DHB CEOs agree that:
6. funding for the additional two treatments should be negotiated between the Ministry of Health and Auckland DHB
7. after two years the effect of LVADs on overall access to transplantation, and the effect on overall transplantation survival rates, be reviewed, for continuation or disinvestment, through the SPNIA framework
8. subject to recommendation 7 above, LVADs, for the next two years, become part of the standard suite of treatment options for heart conditions that meet the criteria proposed in the LVAD business case to NSTR.
Related information
Service Planning and New Health Intervention Assessment (SPNIA)
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Publishing information
Date of publication: November 2008
ISBN numbers: 978-0-478-31853-1 (Online)
HP number: 4706
Citation: Ministry of Health. 2008. Assessment of the Business Case for Left Ventricular Assist Devices. Wellington: Ministry of Health. |
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