Skip to main content
Article thumbnail
Location of Repository

The cost-effectiveness of left ventricular assist devices in end stage heart failure

By Julia Hutchinson, David A. Scott, Andrew J. Clegg, Emma Loveman, Pam Royle, Jackie Bryant and Jill L. Colquitt

Abstract

With a limited supply of donor hearts, individuals with end-stage heart failure have been offered hope through the use of mechanical devices. Left ventricular-assist devices (LVADs) are a technology designed to work in parallel with the heart but have yet to see widespread use since uncertainty remains as to the cost–effectiveness of this evolving new technology. We have systematically reviewed evidence of cost–effectiveness for LVADs in the bridge-to-transplant and long-term chronic support indications. A total of 18 studies reporting costs were identified. Of these, only four studies reported results in cost–effectiveness terms; two in cost per life-year saved and two in cost per quality-adjusted life-year (QALY). The majority of the other studies were simple cost summations (cost per day or incremental cost) without consideration of efficacy. In the bridge-to-transplant indication, a Danish abstract reported a cost per life-year saved of DKK270k (US$48,000), a UK study reported a cost per QALY of GB£39,787 (US$78,000) and a Canadian study reported a cost per life-year saved of Can$91,332 (US$86,000). Regarding the long-term chronic support indication, the same Canadian study reported a cost per life-year saved of Can$59,842 (US$56,000), whereas a US study reported a cost per QALY of $36,255–60,057. Assuming a willingness to pay the threshold of GB£30,000 (US$59,000) per QALY, there is arguably stronger evidence to support the cost–effectiveness of LVAD technology for the long-term chronic support indication. However, the methodological quality of the majority of studies was poor, as was their generalizability, raising concerns over the reliability of these figures. With the limited and declining availability of donor hearts for transplantation, it appears that the future of this technology is in its use as long-term chronic support. Further analyses should be undertaken, particularly alongside randomized, controlled trials and utilizing second- and third-generation devices<br/><br/

Topics: RT, RD
Year: 2008
OAI identifier: oai:eprints.soton.ac.uk:72880
Provided by: e-Prints Soton
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://dx.doi.org/10.1586/1477... (external link)
  • Suggested articles

    Citations

    1. 1) Validation of the method, and 2) use in medical decision making. doi
    2. A long-term ventricular assist device utilizing a magnetic bearing system and implantable physiologic controller. Heart Surg Forum 2001;4:11–2. This version of
    3. (1990). A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: heart rejection study group.
    4. authors would like to know your views about this report.
    5. (1999). Centre for Health Economics, doi
    6. (1995). Clinical experience with BioMedicus centrifugal ventricular support in 172 patients. Artif Organs doi
    7. (1993). Immunofluorescence of endomyocardial biopsy specimens; methods and interpretation. J Heart Lung Transplant
    8. (1995). International Society for Heart and Lung Transplantation. Sixteenth annual data report. URL: http://www.ishlt.org/registry.html 188. Cloy
    9. (1995). Overseas transport of a patient with an extracorporeal left ventricular assist device. Ann Thorac Surg doi
    10. (2005). View/download the appendices (880 kbytes). Health Technology Assessment

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.