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2016 ; 16
(3
): 1-60
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Left Ventricular Assist Devices for Destination Therapy: A Health Technology
Assessment
#MMPMID27026798
ä
Ont Health Technol Assess Ser
2016[]; 16
(3
): 1-60
PMID27026798
show ga
BACKGROUND: Left ventricular assist devices (LVADs) provide circulatory support
to assist the damaged left ventricle in patients with end-stage heart failure.
Implantation of an LVAD is sometimes a last resort for patients with end stage
heart failure who are ineligible for heart transplantation (destination therapy).
First-generation LVADs used pulsatile pumps to mimic the natural pulsing action
of the heart. Implanted second-generation LVADs use a rapidly spinning rotor to
produce a continuous flow of blood into the systemic arterial system. OBJECTIVES:
Our objectives were to: Determine the clinical effectiveness of LVADs for
destination therapy for patients with end-stage heart failure who are ineligible
for heart transplantationEstimate the cost-effectiveness of destination-therapy
LVAD for patients with end-stage heart failure who are ineligible for heart
transplantation and to estimate the potential budget impact for the Ontario
Ministry of Health and Long-Term Care over the next 5 years. METHODS: We
performed a narrative review of the clinical and economic literature for
effectiveness and cost-effectiveness and a budget impact analysis from the
perspective of the Ministry of Health and Long-Term Care. We did not conduct a
meta-analysis of the clinical evidence owing to differences in the type of LVADs
included in the studies. RESULTS: Three systematic reviews and one observational
study contributed to the clinical evidence. Three economic reviews contributed to
the economic evidence. There is moderate quality evidence that treatment with
continuous-flow LVADs improves survival but has higher adverse events rates
compared with drug therapy. Low quality evidence suggests treatment with a
continuous-flow LVADs improves quality of life. The incremental
cost-effectiveness ratio associated with destination-therapy LVAD over optimal
medical management is relatively high and exceeds the traditionally accepted
thresholds ($50,000 to $100,000 per quality-adjusted life-year). The estimated
net budget impact is $13.6 million in 2015, $20.7 million in 2016, $27.8 million
in 2017, $35.8 million in 2018, and $45.0 million in 2019. CONCLUSIONS: For
patients with end-stage heart failure who are ineligible for heart
transplantation, permanent treatment with continuous-flow LVADs is effective at
improving survival and quality of life compared with drug therapy. However,
permanent continuous-flow devices have higher adverse event rates than drug
therapy. Although it improves survival and quality of life, the device itself and
the surgery to implant it are very expensive.