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
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
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.
heart failure, left ventricular assist devices, systematic review, economic evaluation, health technology assessment
2929-2938
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Colquitt, Jill L.
741c69a3-d9e0-4f10-b457-e496541e7915
Royle, Pam
65edd3b7-b4cc-4563-9269-e7ebf23ef425
Bryant, Jackie
cd84de60-e9a2-4d7a-8ec6-6ca6276b12aa
2006
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Colquitt, Jill L.
741c69a3-d9e0-4f10-b457-e496541e7915
Royle, Pam
65edd3b7-b4cc-4563-9269-e7ebf23ef425
Bryant, Jackie
cd84de60-e9a2-4d7a-8ec6-6ca6276b12aa
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), .
(doi:10.1093/eurheartj/ehi857).
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.
This record has no associated files available for download.
More information
Published date: 2006
Keywords:
heart failure, left ventricular assist devices, systematic review, economic evaluation, health technology assessment
Identifiers
Local EPrints ID: 40611
URI: http://eprints.soton.ac.uk/id/eprint/40611
ISSN: 0195-668X
PURE UUID: 1073ff74-3a41-4579-aaeb-3c9fe6a3bcb0
Catalogue record
Date deposited: 06 Jul 2006
Last modified: 16 Mar 2024 04:43
Export record
Altmetrics
Contributors
Author:
David A. Scott
Author:
Pam Royle
Author:
Jackie Bryant
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics