title: Cost-effectiveness of ventricular assist device use in the United Kingdom: results from the evaluation of ventricular assist device programme in the UK (EVAD-UK).
abstract: BACKGROUND
  The UK Department of Health funds ventricular assist device (VAD) implantation as a bridge to transplantation (BTT) at three centers. The cost-effectiveness of this program has not been established.
  
  
  METHODS
  All 70 VAD implants for BTT and a consecutive cohort of 71 inotrope-dependent transplant candidates, between April 2002 and December 2004, were prospectively monitored for survival, transplantation, quality of life and resource use. Costs and quality-adjusted life-years were estimated for these groups, and for a hypothetical scenario in which VAD patients would die within 30 days in the absence of the program.
  
  
  RESULTS
  Mean quality-adjusted life-years for a VAD patient was 3.27 at a lifetime cost of 173,841 pounds (316,078 US dollars). The majority of the cost was attributable to the VAD implant (63,830 pounds, 116,056 US dollars) and the initial hospital stay in the ITU and ward (14,500 pounds, 26,364 US dollars). Inotrope-dependent transplant candidates had mean quality-adjusted life-years of 4.99 at a lifetime cost of 130,905 pounds (238,011 US dollars). The worst clinical scenario resulted in a lifetime cost of 14,400 pounds (26,182 US dollars), based on 1 month in the ICU (mean 15 days). These figures were robust to a range of plausible assumptions.
  
  
  CONCLUSIONS
  A lifetime model based on current UK practice demonstrates that BTT VAD patients had significant quality-adjusted life-years, but treatment was expensive when compared with the worst clinical scenario. If device technology improves, costs are reduced, or referral practice changes, results should be re-assessed.
authors.affiliation: Papworth Hospital NHS Trust, Papworth Everard, Cambridge, UK. linda.sharples@mrc-bsu.cam.ac.uk <linda.sharples@mrc-bsu.cam.ac.uk>
authors.forename: Linda D
authors.initials: LD
authors.lastname: Sharples
authors.forename: Matthew
authors.initials: M
authors.lastname: Dyer
authors.forename: Fay
authors.initials: F
authors.lastname: Cafferty
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Demiris
authors.forename: Carol
authors.initials: C
authors.lastname: Freeman
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Large
authors.forename: Steven
authors.initials: S
authors.lastname: Tsui
authors.forename: Noreen
authors.initials: N
authors.lastname: Caine
authors.forename: Martin
authors.initials: M
authors.lastname: Buxton
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D006113:United Kingdom