A varied approach to left ventricular assist device follow-up improves cost-effectiveness

Abstract

Background

Left ventricular assist device (LVAD) implantation improves outcomes in advanced heart failure, however, the optimal frequency of outpatient assessments to improve cost-effectiveness and potentially avert readmissions is unclear.

Methods

To test if varying the frequency of follow-up after LVAD implantation reduces readmissions and improves cost-effectiveness, a less intensive follow-up (LIFU) strategy with scheduled visits at 1 month and then every 6 months was compared to an intensive follow-up (IFU) group with scheduled visits at 1, 2, and 4 weeks, and then every 3 months post-implant. We developed a decision-tree model to evaluate the cost-effectiveness of different follow-up schedules at 3, 6, and 12-months. The readmission rates for LIFU and IFU, along with the associated costs, were estimated using data from the IBM MarketScan Commercial Claims Databases (2015–2018). A total of 349 patients were enrolled, with 193 and 156 in the IFU and LIFU groups.

Results

Patients with IFU were found to have a lower risk for readmission at 3 months (HR: 0.69, 95% confidence interval (CI): 0.60–0.79), but this difference diminished overtime at 6 months (HR: 0.84, 95% CI: 0.73–0.96) and 12 months (HR: 0.94, 95% CI: 0.83–1.06). The incremental net benefit of IFU, when compared with LIFU, is greatest in the first 3 months and also diminishes over time (3 months: $19616, 6 months $9257, 12 months $717).

Conclusions

An initial IFU strategy, followed by a period of de-escalation at the 6-month post-implant mark in lower-risk patients, may be a more cost-effective strategy to provide follow-up care while not predisposing patients to a higher risk of readmission.

Keywords:

• LVAD
• left ventricular assist device
• cost-effectiveness

Transparency

Declaration of financial/other relationships

No potential conflicts of interest relevant to this article were reported. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

M.A. and H.S. designed the study. P.L., H.S., and J.B. analyzed data and prepared the results. M.A., L.M., and H.S. interpretated the data, wrote, and revised the manuscript.

Acknowledgements

Dr. Hui Shao is the guarantor of this work and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.