Cost-Effectiveness of Left Ventricular Assist Devices in Ambulatory Patients With Advanced Heart Failure

With the everpresent question of potentially extending LVAD therapy to ambulatory patients with advanced heart failure, the authors--using a Markov model--projected the incremental cost-efffectiveness ratio (ICER) of DT LVADs in this population as compared to conventional medical therapy.   The authors find that, although LVADs clearly extend quality-adjusted life-years (QALYs), the ICER is >$200K per QALY.  (Conventional cut-offs for ICER acceptability range from <$50K to <$100K.)  This ICER is thus cost-ineffective at present.   The study finds that this excessive cost is driven predominantly by follow-up care and readmissions, which suggests a potential target for improving ICER in the future.