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.
OBJECTIVE
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.


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 pound 65,242 (95% confidence interval pound 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.


CONCLUSIONS
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.
Clegg
Andrew J
AJ
Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute for Health Research and Development (WIHRD), University of Southampton, Southampton SO16 7PX, UK. a.clegg@soton.ac.uk
Scott
David A
DA
Loveman
Emma
E
Colquitt
Jill L
JL
Royle
Pam
P
Bryant
Jackie
J
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000191:economics / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000191:economics*; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D011788:Quality of Life; D016019:Survival Analysis