Assessment of the Cost-effectiveness of Left Ventricular Assist Device in Patients Who Are Not Suitable for a Heart Transplantation

This study assessed the cost effectiveness of a Left Ventricular Assist Device (LVAD) versus medical therapy (standard treatment in the NHS) in patients unsuitable for heart transplantation. Published studies were used as the main sources of information supplemented by expert (cardiac surgeon & cardiologist) opinion.  This was an indirect analysis, meaning that LVAD and medical therapy data came from different studies rather than from a randomised study in which they were directly compared.

A timescale of five years was used. 

A decision-analytic model was adopted because it represented an explicit way to synthesise evidence on the outcomes and costs in a transparent and flexible manner.  Where possible, English national tariff costs were used so costs reflected true costs paid by the NHS. 

Cost-effectiveness was reported as incremental cost per QALY gained.

Deterministic results (using the reported results from the study and reported costs) and probabilistic results (where the majority of inputs were as probability distributions reflecting the uncertainty in the data) were reported.  1,000 cost-effectiveness results were estimated in the probabilistic analysis.  Also, for the deterministic analysis, sensitivity to changes in the results was assessed and reported as a Tornado Plot (a diagram that looks like a tornado).  Using the probabilistic analysis, a Cost-effectiveness Plane and a Cost-effectiveness Acceptability Curve were constructed, the latter so that the likelihood of cost-effectiveness at various thresholds could be reported.  A Cost-effectiveness Plane shows the number of scenarios that fall into categories of less cost less effective, less cost more effective, more cost less effective and more cost more effective.

A report was prepared showing how the analysis was done and what the results were.  A list of references was included so that it could be seen which sources were used and when internet sources were accessed.