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European Heart Journal Advance Access published online on April 7, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi857
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received November 8, 2005
Revised March 1, 2006
Accepted March 17, 2006

Review

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 1 *, David A. Scott 2, Emma Loveman 1, Jill L. Colquitt 1, Pam Royle 3, and Jackie Bryant 1

1 Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute for Health Research and Development (WIHRD), University of Southampton, Southampton SO16 7PX, UK
2 Fourth Hurdle Consulting Ltd, Holborn Tower, 137-144 High Holborn, London WC1V 6PL, UK
3 Department of Public Health, School of Medicine, University of Aberdeen, Polwarth Building, Aberdeen AB25 2ZD, UK

* To whom correspondence should be addressed.
Andrew J. Clegg, E-mail: a.clegg{at}soton.ac.uk


  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 £65 242 (95% confidence interval £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.

Keywords: Heart failure; Left ventricular assist devices; Systematic review; Economic evaluation; Health technology assessment.
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