Cost-effectiveness of Ventricular Assist Device Use in the United Kingdom: Results From the Evaluation of Ventricular Assist Device Programme in the UK (EVAD-UK) Linda D. Sharples, PhD, Matthew Dyer, MSc, Fay Cafferty, MMath, Nikolaos Demiris, PhD, Carol Freeman, MPhil, Nicholas R. Banner, FRCP, Stephen R. Large, FRCP, FRCS, Steven Tsui, MD, FRCS, Noreen Caine, BA, and Martin Buxton, BA. Background: The UK Department of Health funds ventricular assist device (VAD) implantation as a bridge to transplantation (BTT) at three centers. The cost-effectiveness of this program has not been established. Methods: All 70 VAD implants for BTT and a consecutive cohort of 71 inotrope-dependent transplant candidates, between April 2002 and December 2004, were prospectively monitored for survival, transplantation, quality of life and resource use. Costs and quality-adjusted life-years were estimated for these groups, and for a hypothetical scenario in which VAD patients would die within 30 days in the absence of the program. Results: Mean quality-adjusted life-years for a VAD patient was 3.27 at a lifetime cost of £173,841 (US$316,078). The majority of the cost was attributable to the VAD implant (£63,830, US$116,056) and the initial hospital stay in the ITU and ward (£14,500, US$26,364). Inotrope-dependent transplant candidates had mean quality-adjusted life-years of 4.99 at a lifetime cost of £130,905 (US$238,011). The worst clinical scenario resulted in a lifetime cost of £14,400 (US$26,182), based on 1 month in the ICU (mean 15 days). These figures were robust to a range of plausible assumptions. Conclusions: A lifetime model based on current UK practice demonstrates that BTT VAD patients had significant quality-adjusted life-years, but treatment was expensive when compared with the worst clinical scenario. If device technology improves, costs are reduced, or referral practice changes, results should be re-assessed. J Heart Lung Transplant 2006;25:1336 – 43. Copyright © 2006 by the International Society for Heart and Lung Transplantation. Heart transplantation is widely accepted as the most effective surgical treatment for severe heart failure, with 1-, 5- and 10-year post-transplant survival of 81%, 68% and 48%, respectively, 1 and quality of life compa- rable to age- and gender-matched norms. 2 However, there has been a steady decline in donor hearts over time 3 and alternatives to transplantation are required. 4 A centrally funded program within the NHS was established in 2002 to provide ventricular assist devices (VADs) in three centers in the UK (the Freeman, Harefield and Papworth Hospitals) with the intention of bridge to transplant. The prospective Evaluation of Ventricular Assist Device Program UK (EVAD-UK) study was set up to evaluate the service and focused on clinical/cost-effectiveness. Evaluating low volume, high cost, but potentially life-saving surgical interventions is difficult because randomized, controlled trials (RCTs) of sufficient size are often not feasible. 5 However, evaluation of VADs is important because of its physical and psychologic inva- siveness, and its high cost. Although EVAD-UK could not provide formal trial data it did provide prospective, systematically collected data on a multi-center cohort of patients receiving a VAD and on concurrent inotrope- dependent transplant candidates. METHODS All 70 patients implanted with VADs in the UK Govern- ment–funded program between April 2002 and Decem- ber 2004 were included. Devices used were the Heart- Mate VE (n = 14), Thoratec (PVAD and IVAD, n = 42), Jarvik 2000 (n = 13) and HeartMate II (n = 1). Patients From the Papworth Hospital NHS Trust, Papworth Everard, Cam- bridge, UK. Submitted May 18, 2006; revised July 27, 2006; accepted Septem- ber 9, 2006. Supported by the NHS Health Technology Assessment Programme. Reprint requests: Linda D. Sharples, PhD, Papworth Hospital NHS Trust, Papworth Everard, Cambridge CB3 8RE, UK. Telephone: 00-44-12233-33089. Fax: 00-44-12233-30388. E-mail: linda.sharples@ mrc-bsu.cam.ac.uk Copyright © 2006 by the International Society for Heart and Lung Transplantation. 1053-2498/06/$–see front matter. doi:10.1016/ j.healun.2006.09.011 1336 MECHANICAL CIRCULATORY SUPPORT