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New and Emerging Cardiac Technologies in Australian and New Zealand Public Health Services Over the Next Decade Prepared for Healthpact February 2013

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New and Emerging Cardiac Technologies in Australian and New Zealand Public Health Services Over the Next Decade Prepared for Healthpact February 2013 NEW AND EMERGING CARDIAC TECHNOLOGIES IN AUSTRALIAN AND NEW ZEALAND PUBLIC HEALTH SERVICES OVER THE NEXT DECADE PREPARED FOR HEALTHPACT FEBRUARY 2013 HLW01 NEW AND EMERGING CARDIAC TECHNOLOGIES IN AUSTRALIA AND NEW ZEALAND TABLE OF CONTENTS BACKGROUND AND CONTEXT ................................................................................................... 1 The burden of cardiovascular diseases ........................................................................................ 1 CVD and service demand ........................................................................................................... 1 This review.................................................................................................................................. 3 Scope and limitations of the review ............................................................................................ 3 REVIEW METHODS ......................................................................................................................... 4 Background analysis and literature review ................................................................................. 4 Consultation with expert informants ........................................................................................... 5 Financial analysis ........................................................................................................................ 5 Included technologies ................................................................................................................. 6 Device costs ................................................................................................................................ 6 PERCUTANEOUS VALVE REPLACEMENT AND REPAIR ..................................................... 8 TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) ............................................ 9 Background ................................................................................................................................. 9 Technology ............................................................................................................................... 11 Evidence of effectiveness ......................................................................................................... 12 Evidence of cost-effectiveness .................................................................................................. 15 Impacts on service delivery ...................................................................................................... 20 TRANSCATHETER MITRAL VALVE REPAIR AND REPLACEMENT ............................... 23 Background ............................................................................................................................... 23 Technologies – mitral valve repair ............................................................................................ 25 Technologies – mitral valve replacement ................................................................................. 27 Evidence of effectiveness ......................................................................................................... 27 Evidence of cost-effectiveness .................................................................................................. 31 Impacts on service delivery ...................................................................................................... 33 LEFT ATRIAL APPENDAGE OCCLUSION DEVICES ............................................................ 35 Background ............................................................................................................................... 35 Technology ............................................................................................................................... 37 Evidence of effectiveness ......................................................................................................... 38 Evidence of cost-effectiveness .................................................................................................. 42 Impacts on service delivery ...................................................................................................... 45 PUMPS / ASSIST DEVICES AS A DESTINATION THERAPY FOR THE MANAGEMENT OF HEART FAILURE ...................................................................................... 47 Background ............................................................................................................................... 47 Technology ............................................................................................................................... 51 Evidence of effectiveness ......................................................................................................... 53 Evidence of cost-effectiveness .................................................................................................. 55 Impacts on service delivery ...................................................................................................... 57 NEXT GENERATION PACEMAKER AND IMPLANTABLE CARDIAC DEFIBRILLATOR DEVICES ......................................................................................................... 59 Background ............................................................................................................................... 59 Technology ............................................................................................................................... 64 1111168327 \ 0256429 \ HLW01 i NEW AND EMERGING CARDIAC TECHNOLOGIES IN AUSTRALIA AND NEW ZEALAND Evidence of effectiveness ......................................................................................................... 67 Evidence of cost-effectiveness .................................................................................................. 68 Impacts on service delivery ...................................................................................................... 69 RENAL SYMPATHETIC DENERVATION FOR THE TREATMENT OF RESISTANT HYPERTENSION ..................................................................................................... 71 Background ............................................................................................................................... 71 Technology ............................................................................................................................... 73 Evidence of effectiveness ......................................................................................................... 74 Evidence of cost-effectiveness .................................................................................................. 76 Impacts on service delivery ...................................................................................................... 79 GENETIC TESTING IN THE ASSESSMENT AND MANAGEMENT OF CARDIOVASCULAR DISEASES .................................................................................................. 81 Background ............................................................................................................................... 81 Technology ............................................................................................................................... 83 Evidence of effectiveness ......................................................................................................... 88 Evidence of cost-effectiveness .................................................................................................. 91 Impacts on service delivery ...................................................................................................... 92 SUMMARY ....................................................................................................................................... 94 APPENDIX 1 – ‘BREAKTHROUGH TECHNOLOGIES’ .......................................................... 96 DIAGNOSTIC TECHNOLOGIES ................................................................................................. 96 Cardiac monitoring ................................................................................................................... 96 Wireless pulmonary artery haemodynamic monitor 96 Next generation remote cardiac arrhythmia monitoring 96 Smart T shirt 97 Electrophysiology ..................................................................................................................... 98 Stretchable silicon electronics 98 Imaging ..................................................................................................................................... 98 Combination intracardiac echocardiography and ultrasound system 98 High resolution miniature ultrasound probe 99 Ultrafast single-photon emission computed tomography (SPECT) 99 TREATMENT TECHNOLOGIES ............................................................................................... 101 Chamber .................................................................................................................................. 101 C-Pulse cardiac assist device 101 Cardiac tissue engineering 101 Electrophysiology ................................................................................................................... 102 Next generation balloon ablation technologies 102 Epicardial ablation system 103 Guided medical positioning system 103 Wireless cardiac stimulator 104 Microelectronic pacemaker
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