Cost-effectiveness of bivalirudin in pediatric ventricular assist devices

被引：4

作者：

Burstein, Danielle ^{[1
,10
]}

Kimmel, Stephen ^{[2
]}

Putt, Mary ^{[3
]}

Rossano, Joseph ^{[1
]}

VanderPluym, Christina ^{[4
]}

Ankola, Ashish ^{[5
]}

Lorts, Angela ^{[6
]}

Maeda, Katsuhide ^{[7
]}

O'Connor, Matthew ^{[1
]}

Edelson, Jonathan ^{[1
]}

Lin, Kimberly ^{[1
]}

Buchholz, Holger ^{[8
]}

Conway, Jennifer ^{[9
]}

机构：

[1] Childrens Hosp Philadelphia, Div Cardiol, Philadelphia, PA USA

[2] Univ Florida, Coll Publ Hlth & Hlth Profess, Dept Epidemiol, Gainesville, FL USA

[3] Univ Penn, Dept Biostat & Epidemiol, Perelman Sch Med, Philadelphia, PA USA

[4] Boston Childrens Hosp, Div Cardiol, Boston, MA USA

[5] Texas Childrens Hosp, Div Cardiol, Houston, TX USA

[6] Cincinnati Childrens Med Ctr, Div Cardiol, Cincinnati, OH USA

[7] Childrens Hosp Philadelphia, Dept Cardiothorac Surg, Philadelphia, PA USA

[8] Univ Alberta, Div Cardiothorac Surg, Edmonton, AB, Canada

[9] Univ Alberta, Div Cardiol, Edmonton, AB, Canada

[10] Childrens Hosp Philadelphia, 34th St & Civ Ctr Blvd, Philadelphia, PA 19104 USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2023年 / 42卷 / 03期

关键词：

anticoagulation; pediatric; ventricular assist device; cost-effectiveness; outcomes; BERLIN HEART EXCOR; INTERAGENCY REGISTRY; PROSPECTIVE TRIAL; OUTCOMES; CHILDREN;

D O I：

10.1016/j.healun.2022.10.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Despite recent data suggesting improved outcomes with bivalirudin vs heparin in pedi-atric Ventricular assist devices (VAD), higher costs remain a barrier. This study quantified trends in bivalirudin use and compared outcomes, resource utilization, and cost-effectiveness associated with bivalirudin vs heparin.METHODS: Children age 0 to 6 year who received VAD from 2009 to 2021 were identified in Pediatric Health Information System. Bivalirudin use was evaluated using trend analysis and outcomes were compared using Fine-Gray subdistrubtion hazard ratios (SHR). Daily-level hospital costs were compared due to differences in length of stay. Cost-effectiveness was evaluated using incremental cost-effectiveness ratio (ICER).RESULTS: Of 691 pediatric VAD recipients (median age 1 year, IQR 0-2), 304 (44%) received bivaliru-din with 90% receiving bivalirudin in 2021 (trend p-value <0.01). Bivalirudin had lower hospital mor-tality (26% vs 32%; adjusted SHR 0.57, 95% CI 0.40-0.83) driven by lower VAD mortality (20% vs 27%; adjusted SHR 0.46, 95% CI 0.32-0.77) after adjusting for year, age, diagnosis, and center VAD volume. Post-VAD length of stay was longer for bivalirudin than heparin (median 91 vs 64 days, respectively, p < 0.001). Median daily-level costs were lower among bivalirudin (cost ratio 0.87, 95% CI 0.79-0.96) with higher pharmacy costs offset by lower imaging, laboratory, supply, and room/board costs. Estimated ICER for bivalirudin vs heparin was $61,192 per quality-adjusted life year gained with a range of $27,673 to $131,243.CONCLUSIONS: Bivalirudin use significantly increased over the past decade and is now used in 90% young pediatric VAD recipients. Bivalirudin was associated with significantly lower hospital mortality and an ICER <$65,000, making it a cost-effective therapy for pediatric VAD recipients. J Heart Lung Transplant 2023;42:390-397 (c) 2022 International Society for Heart and Lung Transplantation. All rights reserved.

引用

页码：390 / 397

页数：8

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