{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T21:14:33Z","timestamp":1774473273746,"version":"3.50.1"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["NIHR128996"],"award-info":[{"award-number":["NIHR128996"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Left Ventricular Assist Devices (LVADs) for destination therapy (DT) are used in many countries but in some, like the UK, LVADs are not commissioned due to uncertainty around their cost-effectiveness. Existing economic evaluations of LVADs for these patients have limitations. This study aimed to estimate the cost-effectiveness of LVADs as destination therapy, compared to optimal medical therapy, in the UK.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cost-utility analysis from a UK healthcare perspective was conducted, using a Markov model. The model incorporated the impact of major events and complications. Sub-group analyses considered different severities of heart failure on cost-effectiveness. Uncertainty was measured in deterministic and probabilistic sensitivity analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>LVAD produced additional 2.78 (95% CI 2.46\u20133.14) QALYs at an incremental cost of \u00a3152,329 (95% CI \u00a3125,665 - \u00a3181,812) compared to medical management, giving an incremental cost-effectiveness ratio (ICER) of \u00a354,748 per QALY. The ICER remained above the accepted thresholds of cost-effectiveness in the UK if a small proportion of patients receiving LVAD becomes eligible for a heart transplant and for all subgroups based on heart failure severity. The deterministic sensitivity analysis showed that the ongoing outpatient costs had a significant impact on the results.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our analysis found that LVADs are not cost-effective as destination therapy in the UK if a willingness to pay threshold of \u00a350,000 per QALY gained or disease severity modifiers, were applied. Robust data on ongoing costs for LVAD and medical management are needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0312912","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T18:35:26Z","timestamp":1733337326000},"page":"e0312912","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-effectiveness of Left Ventricular Assist Devices (LVADs) as destination therapy in the UK: An economic modelling study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4143-3852","authenticated-orcid":true,"given":"Tuba","family":"Sayg\u0131n Av\u015far","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pelham","family":"Barton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie","family":"Beese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoong S.","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2465-305X","authenticated-orcid":true,"given":"David","family":"Quinn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm","family":"Price","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Moor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"issue":"1","key":"pone.0312912.ref001","first-page":"1","article-title":"The clinical and cost-effectiveness of left ventricular assist devices for end-stage heart failure: a systematic review and economic evaluation","volume":"9","author":"A. Clegg","year":"2005","journal-title":"Health technology assessment"},{"key":"pone.0312912.ref002","unstructured":"National Institute for Health and Care Excellence [NICE], Chronic heart failure in adults: diagnosis and management. 2018."},{"issue":"3","key":"pone.0312912.ref003","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/S1388-9842(01)00198-2","article-title":"The current cost of heart failure to the National Health Service in the UK","volume":"4","author":"S. Stewart","year":"2002","journal-title":"European Journal of Heart Failure"},{"key":"pone.0312912.ref004","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s40273-020-00952-0","article-title":"A systematic review of medical costs associated with heart failure in the USA (2014\u20132020)","author":"M. Urbich","year":"2020","journal-title":"Pharmacoeconomics"},{"key":"pone.0312912.ref005","unstructured":"National Institute for Health and Care Excellence [NICE], Short-term circulatory support with left ventricular assist devices as a bridge to cardiac transplantation or recovery, in Interventional procedures guidance [IPG177]. 2006, National Institute for Health and Care Excellence: United Kingdom."},{"issue":"2","key":"pone.0312912.ref006","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1161\/CIRCULATIONAHA.118.037231","article-title":"Comprehensive Analysis of Stroke in the Long-Term Cohort of the MOMENTUM 3 Study","volume":"139","author":"P.C. Colombo","year":"2019","journal-title":"Circulation"},{"key":"pone.0312912.ref007","article-title":"(Accepted\/In press)., Clinical and Cost-effectiveness of Left Ventricular Assist Devices as Destination Therapy for Advanced Heart Failure: Systematic Review and Economic Evaluation","author":"S. Beese","journal-title":"2024: Health Technology Assessment"},{"key":"pone.0312912.ref008","unstructured":"National Institute for Health and Care Excellence [NICE]. NICE health technology evaluations: the manual. 2022 17.05.2022]; Available from: https:\/\/www.nice.org.uk\/process\/pmg9\/resources\/guide-to-the-methods-of-technology-appraisal-2013-pdf-2007975843781."},{"issue":"4","key":"pone.0312912.ref009","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1002\/ehf2.13401","article-title":"Cost\u2010effectiveness of left ventricular assist devices as destination therapy in the United Kingdom","volume":"8","author":"S. Schueler","year":"2021","journal-title":"ESC heart failure"},{"key":"pone.0312912.ref010","article-title":"A Clinical and Cost-effectiveness Analysis of The HeartMate 3 Left Ventricular Assist Device for Transplant-ineligible Patients: A United Kingdom Perspective","author":"H.S. Lim","year":"2022","journal-title":"The Journal of Heart and Lung Transplantation"},{"key":"pone.0312912.ref011","unstructured":"ONS, National life tables\u2013life expectancy in the UK: 2018 to 2020. 2021."},{"key":"pone.0312912.ref012","article-title":"Cost-Effectiveness of Interventions for Smoking Cessation","author":"S. Flack","journal-title":"2007, York Health Economics Consortium"},{"issue":"20","key":"pone.0312912.ref013","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1056\/NEJMoa012175","article-title":"Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure","volume":"345","author":"E.A. Rose","year":"2001","journal-title":"New England Journal of Medicine"},{"issue":"4","key":"pone.0312912.ref014","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1001\/jamacardio.2019.5323","article-title":"Association of Clinical Outcomes With Left Ventricular Assist Device Use by Bridge to Transplant or Destination Therapy Intent: The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 (MOMENTUM 3) Randomized Clinical Trial","volume":"5","author":"D.J. Goldstein","year":"2020","journal-title":"JAMA Cardiology"},{"key":"pone.0312912.ref015","article-title":"Quality-Adjusted Life Expectancy Norms for the English Population","author":"S. McNamara","year":"2022","journal-title":"Value in Health"},{"key":"pone.0312912.ref016","doi-asserted-by":"crossref","DOI":"10.1016\/j.jval.2023.05.015","article-title":"The evolving nature of Health Technology Assessment: a critical appraisal of NICE\u2019s new methods manual","author":"A. Angelis","year":"2023","journal-title":"Value in Health"},{"issue":"8","key":"pone.0312912.ref017","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/j.jval.2022.02.004","article-title":"Considering Severity in Health Technology Assessment: Can We Do Better?","volume":"25","author":"C. Skedgel","year":"2022","journal-title":"Value in Health"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0321324","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312912","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T18:35:37Z","timestamp":1733337337000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0312912"}},"subtitle":[],"editor":[{"given":"Francesco","family":"Curcio","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,12,4]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0312912","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,4]]}}}