{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:17:51Z","timestamp":1788992271223,"version":"build-2803163510"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Treatment options for end-stage heart failure include inotrope-dependent medical therapy, orthotopic heart transplantation (OHT), left ventricular assist device (LVAD) as destination therapy or bridge to transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>We developed a state-transition model to simulate 4 treatment options and associated morbidity and mortality. Transition probabilities, costs, and utilities were estimated from published sources. Calculated outcomes included survival, quality-adjusted life-years, and incremental cost-effectiveness. Sensitivity analyses were performed on model parameters to test robustness. Average life expectancy for OHT-eligible patients is estimated at 1.1 years, with 39% surviving to 1 year. OHT with a median wait time of 5.6 months is estimated to increase life expectancy to 8.5 years, and costs &lt;$100\u2009000\/quality-adjusted life-year gained, relative to inotrope-dependent medical therapy. Bridge to transplant-LVAD followed by OHT further is estimated to increase life expectancy to 12.3 years, for $226\u2009000\/quality-adjusted life-year gained versus OHT. Among OHT-ineligible patients, mean life expectancy with inotrope-dependent medical therapy is estimated at 9.4 months, with 26% surviving to 1 year. Patients who instead received destination therapy-LVAD are estimated to live 4.4 years on average from extrapolation of recent constant hazard rates beyond the first year. This strategy costs $202\u2009000\/quality-adjusted life-year gained, relative to inotrope-dependent medical therapy. Patient\u2019s age, time on wait list, and costs associated with care influence outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Under most scenarios, OHT prolongs life and is cost effective in eligible patients. Bridge to transplant-LVAD is estimated to offer &gt;3.8 additional life-years for patients waiting \u22656 months, but does not meet conventional cost-effectiveness thresholds. Destination therapy-LVAD significantly improves life expectancy in OHT-ineligible patients. However, further reductions in adverse events or improved quality of life are needed for destination therapy-LVAD to be cost effective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.113.000807","type":"journal-article","created":{"date-parts":[[2014,2,22]],"date-time":"2014-02-22T01:28:59Z","timestamp":1393032539000},"page":"470-478","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":125,"title":["Comparative Survival and Cost-Effectiveness of Advanced Therapies for End-Stage Heart Failure"],"prefix":"10.1161","volume":"7","author":[{"given":"Elisa F.","family":"Long","sequence":"first","affiliation":[{"name":"From Decisions, Operations &amp; Technology Management, UCLA Anderson School of Management, Los Angeles, CA (E.F.L.); Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.); and Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT (A.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary W.","family":"Swain","sequence":"additional","affiliation":[{"name":"From Decisions, Operations &amp; Technology Management, UCLA Anderson School of Management, Los Angeles, CA (E.F.L.); Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.); and Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT (A.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abeel A.","family":"Mangi","sequence":"additional","affiliation":[{"name":"From Decisions, Operations &amp; Technology Management, UCLA Anderson School of Management, Los Angeles, CA (E.F.L.); Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.); and Section of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT (A.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra021498"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0b013e31828124ad"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90455-A"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000296273.72952.39"},{"key":"e_1_3_2_6_2","unstructured":"American Heart Association. 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