title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Clegg
authors.forename: David A
authors.initials: DA
authors.lastname: Scott
authors.forename: Emma
authors.initials: E
authors.lastname: Loveman
authors.forename: Jill L
authors.initials: JL
authors.lastname: Colquitt
authors.forename: Pam
authors.initials: P
authors.lastname: Royle
authors.forename: Jackie
authors.initials: J
authors.lastname: Bryant
mesh_terms: 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