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Experts urge limit to ventricular assist device use
28 November 2006
Use of left ventricular assist devices (VADs) to allow heart failure (HF) patients gain strength while they wait for a heart transplant should continue to be restricted to certain patients, experts say after reviewing outcomes with and cost-effectiveness of the devices.
“Although we believe that the devices have been developed sufficiently to prolong life for some very sick patients who have rapidly deteriorating HF, we don’t feel they’ve been developed quite enough yet for widespread use amongst the whole HF population,” said lead researcher Linda Sharples, from the Medical Research Council Biostatistics Unit, in Cambridge, UK.
Sharples and team studied 70 patients implanted with a VAD as a bridge to transplantation between April 2002 and December 2004, and 250 non-VAD-supported transplant candidates listed during the same period.
Thirty (43%) of the patients fitted with a VAD died pretransplant, while 31 (44%) underwent transplantation, and four (6%) recovered and had the device removed.
Survival among the assisted patients was high, at 52% at 1 year, the authors report in the review, published in the journal Health Technology Assessment.
However, the estimated cost of a VAD implant operation was £63,803 (US $116,000), and the total healthcare cost was higher than that for the sickest patients in the non-VAD group, who also had greater survival rates.
“Overall survival of 52% is an excellent clinical achievement for those young patients with rapidly failing hearts,” the authors conclude.
“However, if the worst case scenario were plausible, and one could reliably extrapolate results to the lifetime of patients, VADs would not be cost-effective at traditional thresholds.”
Sharples commented further: “We recommend that the UK continues to monitor the development of the new devices. I think we are all quite hopeful that they will progress and we will have more cost-effective and effective devices in the future.”
