Key result
Bridge-to-transplant LVADs improve survival over usual care at ~£65,000 per quality-adjusted life year.
Why the study?
The clinical and cost-effectiveness of left ventricular assist devices as a bridge to transplant for people with end-stage heart failure required evaluation through systematic review and economic analysis.
Are left ventricular assist devices clinically and cost-effective as a bridge to transplant compared with usual care in people with end-stage heart failure?
Systematic Review
Are left ventricular assist devices clinically and cost-effective as a bridge to transplant compared with usual care in people with end-stage heart failure?
Effect estimate: 65,242 pounds per QALY (95% CI 34,194-364,564 pounds)
LVADs as a bridge to transplant in end-stage heart failure appear clinically effective but are unlikely to be cost-effective at current costs.
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 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. 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.
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Clegg et al. (2006) conducted a systematic review in End-stage heart failure. Left ventricular assist devices (LVADs) vs. Usual care was evaluated on Cost per quality adjusted life year (QALY) (65,242 pounds per QALY, 95% CI 34,194-364,564 pounds). Left ventricular assist devices as a bridge to transplant improved survival but had a high cost per quality adjusted life year of 65,242 pounds (95% CI 34,194-364,564) compared with usual care.
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