COST-EFFECTIVENESS OF LEFT VENTRICULAR ASSIST DEVICE (LVAD): A SYSTEMATIC REVIEW

Abstract

End-stage heart failure is a syndrome that occurs when the heart is unable to fully perform its function. Due to the inability to pump enough blood to the body, various disorders accompany end-stage heart failure. The gold treatment for end-stage heart failure is heart transplantation, but LVAD treatment is applied due to the lack of sufficient donors. The aim of this study is to perform a systematic review of studies that reveal the economic evaluation of LVAD treatment. Four databases (PubMed, Web of Science, Science Direct, EBSCHO and Ulakbim) were searched for the period 2000-2023. The search yielded 165 articles and 20 articles were included in the study based on various inclusion and exclusion criteria. The quality of the included articles was evaluated by the researchers using the CHEERS score. It was observed that most of the articles were conducted between 2012-2017 (35%), were conducted from a reimbursement perspective (80%), and generally took a lifetime time frame (70%). The studies mostly applied a 3% discount rate (40%) and generally used the Markov model (75%). In the systematic review, LVAD was found to be above the cost-effectiveness thresholds of the countries, both as a target treatment and as a bridge treatment, with the exception of the Japanese study. For LVAD to be cost-effective, it is recommended to reduce the acquisition cost.

Keywords

• Heart Failure
• Heart Transplantation
• LVAD
• Economic Evaluation
• Systematic Review

SOL VENTRİKÜL DESTEK CİHAZLARININ (LVAD) MALİYET ETKİLİLİĞİ: SİSTEMATİK BİR İNCELEME

Öz

Son dönem kalp yetmezliği, kalbin görevini tam olarak yerine getirememesi sonucu ortaya çıkan bir sendromdur. Vücuda yeterli kanın pompalanamaması nedeniyle çeşitli rahatsızlıklarda son dönem kalp yetmezliğine eşlik etmektedir. Son dönem kalp yetmezliğinin altın tedavisi kalp naklidir ancak yeterli donör bulunamaması nedeniyle LVAD tedavisi uygulanmaktadır. Bu çalışmanın amacı, LVAD tedavisinin ekonomik değerlendirmesini ortaya koyan araştırmaların sistematik taramasını gerçekleştirmektir. Sistematik tarama kapsamında 2000-2023 yılları arasını içerecek şekilde dört veri tabanı (PubMed, Web of Science, Science Direct, EBSCHO ve Ulakbim) taranmıştır. Tarama kapsamında 165 makale bulunmuş ve çeşitli dâhil etme ve dışlama kriterleri kapsamında 20 makale çalışmaya alınmıştır. Dâhil edilen makalelerin kaliteleri CHEERS puanı ile araştırmacılar tarafından değerlendirilmiştir. Araştırmaların en çok 2012-2017 yılları arasında yapıldığı (%35), geri ödeyici perspektiften gerçekleştirildiği (%80) ve genellikle ömür boyu zaman dilimi (%70) alındığı görülmüştür. Çalışmalarda çoğunlukla %3 indirim oranı uygulanmış (%40) ve genellikle markov modeli (%75) kullanılmıştır. Sistematik tarama sonucunda Japonya’da yapılan çalışma haricinde LVAD hem hedef tedavi olarak hem de köprü tedavi olarak, ülkelerin maliyet etkililik eşiklerinin üzerinde bulunmuştur. LVAD’ın maliyet etkili olabilmesi için alış maliyetinin düşürülmesi önerilmektedir.

Anahtar Kelimeler

• Kalp Yetmezliği
• Kalp Nakli
• LVAD
• Ekonomik Değerlendirme
• Sistematik Tarama

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