Clinical and cost effectiveness of left ventricular assist devices as a bridge to heart transplantation for people with end stage heart failure: a systematic review and economic evaluation


Clegg, Andrew J., Scott, David A., Loveman, Emma, Colquitt, Jill L., Royle, Pam and Bryant, Jackie (2006) Clinical and cost effectiveness of left ventricular assist devices as a bridge to heart transplantation for people with end stage heart failure: a systematic review and economic evaluation. European Heart Journal, 27, (24), 2929-2938. (doi:10.1093/eurheartj/ehi857).

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Original Publication URL: http://dx.doi.org/10.1093/eurheartj/ehi857

Description/Abstract

Aims
To evaluate the clinical and cost-effectiveness of left ventricular (LV) assist devices (LVADs) as a bridge to transplant (BTT) for people with end-stage heart failure (ESHF) through a systematic review and economic evaluation.

Methods and results
The systematic review and economic evaluation was conducted according to internationally recognized methods. The search strategy identified systematic reviews, randomized controlled trials, quasi-experimental studies, and observational studies evaluating the effects of LVADs on survival, functional capacity, and quality of life.

Cost-effectiveness was assessed through a 5-year decision analytic model to estimate the incremental cost-effectiveness ratio of LVADs compared with usual care. Despite the poor methodological quality of the 18 studies included, LVADs appear beneficial improving survival, functional status, and quality of life. Adverse events are a serious concern.

The economic evaluation showed that LVADs had a cost per quality adjusted life year of £65 242 (95% confidence interval £34 194--364 564). Sensitivity analysis showed that post-heart transplant survival gains, pre-heart transplant patient utility, and one-off costs associated with implantation determine cost-effectiveness.

Conclusion
Although LVADs appear clinically effective as a BTT for people with ESHF, it is unlikely that they will be cost-effective unless costs decrease or the benefits of their use increase.

Item Type: Article
ISSNs: 0195-668X (print)
Related URLs:
Keywords: heart failure, left ventricular assist devices, systematic review, economic evaluation, health technology assessment
Subjects: T Technology > T Technology (General)
R Medicine > RD Surgery
H Social Sciences > HB Economic Theory
Divisions: University Structure - Pre August 2011 > School of Medicine > Developmental Origins of Health and Disease
ePrint ID: 40611
Date Deposited: 06 Jul 2006
Last Modified: 27 Mar 2014 18:25
Contact Email Address: a.clegg@soton.ac.uk
URI: http://eprints.soton.ac.uk/id/eprint/40611

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