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Clinical and cost-effectiveness of left ventricular assist devices as destination therapy for people with end-stage heart failure: A systematic review and economic evaluation

Published online by Cambridge University Press:  01 April 2007

Andrew J. Clegg ,
David A. Scott ,
Emma Loveman ,
Jill Colquitt ,
Pam Royle  and
Jackie Bryant
Andrew J. Clegg
Affiliation:
University of Southampton
David A. Scott
Affiliation:
Oxford Outcomes Ltd.
Emma Loveman
Affiliation:
University of Southampton
Jill Colquitt
Affiliation:
University of Southampton
Pam Royle
Affiliation:
University of Aberdeen
Jackie Bryant
Affiliation:
University of Southampton
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Abstract

Objectives: The clinical and cost-effectiveness of left ventricular assist devices as destination therapy for people with end-stage heart failure is assessed through a systematic review and economic evaluation.

Methods: Systematic review was performed of randomized controlled trials, quasiexperimental studies, case series, and case studies identified through searching eighteen electronic databases, bibliographies, and consultation with experts and manufacturers. Studies assessed 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 for using left ventricular assist devices compared with usual care.

Results: Six studies met the inclusion criteria, showing that left ventricular assist devices appear beneficial, improving survival and quality of life. Adverse events are a serious concern. The economic evaluation showed that left ventricular assist devices had a cost per quality adjusted life year of £170,616. Sensitivity analysis showed that the cost-effectiveness was not sensitive to changes in costs or utility.

Conclusions: Although left ventricular assist devices appear clinically effective as destination therapy, it is unlikely they will be cost-effective unless costs decrease or the benefits of their use increase.

Keywords

Heart failureLeft ventricular assist devicesSystematic reviewEconomic evaluationHealth technology assessment
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 261 - 268
Copyright
Copyright © Cambridge University Press 2007

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