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The cost-effectiveness of left ventricular assist devices in end stage heart failure

The cost-effectiveness of left ventricular assist devices in end stage heart failure
The cost-effectiveness of left ventricular assist devices in end stage heart failure
With a limited supply of donor hearts, individuals with end-stage heart failure have been offered hope through the use of mechanical devices. Left ventricular-assist devices (LVADs) are a technology designed to work in parallel with the heart but have yet to see widespread use since uncertainty remains as to the cost–effectiveness of this evolving new technology. We have systematically reviewed evidence of cost–effectiveness for LVADs in the bridge-to-transplant and long-term chronic support indications. A total of 18 studies reporting costs were identified. Of these, only four studies reported results in cost–effectiveness terms; two in cost per life-year saved and two in cost per quality-adjusted life-year (QALY). The majority of the other studies were simple cost summations (cost per day or incremental cost) without consideration of efficacy. In the bridge-to-transplant indication, a Danish abstract reported a cost per life-year saved of DKK270k (US$48,000), a UK study reported a cost per QALY of GB£39,787 (US$78,000) and a Canadian study reported a cost per life-year saved of Can$91,332 (US$86,000). Regarding the long-term chronic support indication, the same Canadian study reported a cost per life-year saved of Can$59,842 (US$56,000), whereas a US study reported a cost per QALY of $36,255–60,057. Assuming a willingness to pay the threshold of GB£30,000 (US$59,000) per QALY, there is arguably stronger evidence to support the cost–effectiveness of LVAD technology for the long-term chronic support indication. However, the methodological quality of the majority of studies was poor, as was their generalizability, raising concerns over the reliability of these figures. With the limited and declining availability of donor hearts for transplantation, it appears that the future of this technology is in its use as long-term chronic support. Further analyses should be undertaken, particularly alongside randomized, controlled trials and utilizing second- and third-generation devices

cost–effectiveness, end-stage heart failure, left ventricular-assist device, mechanical circulatory support, quality-adjusted life-year
1477-9072
175-185
Hutchinson, Julia
39740423-39b2-47d7-a289-a291d317c0ac
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Royle, Pam
65edd3b7-b4cc-4563-9269-e7ebf23ef425
Bryant, Jackie
cd84de60-e9a2-4d7a-8ec6-6ca6276b12aa
Colquitt, Jill L.
741c69a3-d9e0-4f10-b457-e496541e7915
Hutchinson, Julia
39740423-39b2-47d7-a289-a291d317c0ac
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Royle, Pam
65edd3b7-b4cc-4563-9269-e7ebf23ef425
Bryant, Jackie
cd84de60-e9a2-4d7a-8ec6-6ca6276b12aa
Colquitt, Jill L.
741c69a3-d9e0-4f10-b457-e496541e7915

Hutchinson, Julia, Scott, David A., Clegg, Andrew J., Loveman, Emma, Royle, Pam, Bryant, Jackie and Colquitt, Jill L. (2008) The cost-effectiveness of left ventricular assist devices in end stage heart failure. Expert Review of Cardiovascular Therapy, 6 (2), 175-185. (doi:10.1586/14779072.6.2.175).

Record type: Article

Abstract

With a limited supply of donor hearts, individuals with end-stage heart failure have been offered hope through the use of mechanical devices. Left ventricular-assist devices (LVADs) are a technology designed to work in parallel with the heart but have yet to see widespread use since uncertainty remains as to the cost–effectiveness of this evolving new technology. We have systematically reviewed evidence of cost–effectiveness for LVADs in the bridge-to-transplant and long-term chronic support indications. A total of 18 studies reporting costs were identified. Of these, only four studies reported results in cost–effectiveness terms; two in cost per life-year saved and two in cost per quality-adjusted life-year (QALY). The majority of the other studies were simple cost summations (cost per day or incremental cost) without consideration of efficacy. In the bridge-to-transplant indication, a Danish abstract reported a cost per life-year saved of DKK270k (US$48,000), a UK study reported a cost per QALY of GB£39,787 (US$78,000) and a Canadian study reported a cost per life-year saved of Can$91,332 (US$86,000). Regarding the long-term chronic support indication, the same Canadian study reported a cost per life-year saved of Can$59,842 (US$56,000), whereas a US study reported a cost per QALY of $36,255–60,057. Assuming a willingness to pay the threshold of GB£30,000 (US$59,000) per QALY, there is arguably stronger evidence to support the cost–effectiveness of LVAD technology for the long-term chronic support indication. However, the methodological quality of the majority of studies was poor, as was their generalizability, raising concerns over the reliability of these figures. With the limited and declining availability of donor hearts for transplantation, it appears that the future of this technology is in its use as long-term chronic support. Further analyses should be undertaken, particularly alongside randomized, controlled trials and utilizing second- and third-generation devices

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Published date: February 2008
Keywords: cost–effectiveness, end-stage heart failure, left ventricular-assist device, mechanical circulatory support, quality-adjusted life-year

Identifiers

Local EPrints ID: 72880
URI: http://eprints.soton.ac.uk/id/eprint/72880
ISSN: 1477-9072
PURE UUID: 05f8747b-a724-4c85-bed7-1c0ddac25a17
ORCID for David A. Scott: ORCID iD orcid.org/0000-0001-6475-8046

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Date deposited: 24 Feb 2010
Last modified: 14 Mar 2024 03:17

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Contributors

Author: Julia Hutchinson
Author: David A. Scott ORCID iD
Author: Andrew J. Clegg
Author: Emma Loveman
Author: Pam Royle
Author: Jackie Bryant

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