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

Andrew J. Clegg, David A. Scott, Emma Loveman, Jill L. Colquitt, Pamela Lee Royle, Jackie Bryant

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

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 65 pound 242 (95% confidence interval 34 pound 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.

Original languageEnglish
Pages (from-to)2929-2938
Number of pages10
JournalEuropean Heart Journal
Volume27
Issue number24
Early online date7 Apr 2006
DOIs
Publication statusPublished - 1 Dec 2006

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Heart-Assist Devices
Heart Transplantation
Cost-Benefit Analysis
Heart Failure
Equipment and Supplies
Transplants
Costs and Cost Analysis
Quality of Life
Survival
Quality-Adjusted Life Years
Observational Studies
Randomized Controlled Trials
Confidence Intervals

Keywords

  • heart failure
  • left ventricular assist devices
  • systematic review
  • economic evaluation
  • health technology assessment
  • mechanical circulatory support
  • quality of Life
  • long term use
  • cardiac transplantation
  • destination therapy
  • Jarvik 2000 heart
  • experience
  • flow
  • survival
  • implantation

Cite this

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. / Clegg, Andrew J.; Scott, David A.; Loveman, Emma; Colquitt, Jill L.; Royle, Pamela Lee; Bryant, Jackie.

In: European Heart Journal, Vol. 27, No. 24, 01.12.2006, p. 2929-2938.

Research output: Contribution to journalArticle

Clegg, Andrew J. ; Scott, David A. ; Loveman, Emma ; Colquitt, Jill L. ; Royle, Pamela Lee ; Bryant, Jackie. / 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. In: European Heart Journal. 2006 ; Vol. 27, No. 24. pp. 2929-2938.
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abstract = "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 65 pound 242 (95{\%} confidence interval 34 pound 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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AB - 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 65 pound 242 (95% confidence interval 34 pound 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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