Left ventricular assist device (LVAD) as destination therapy for patients with endstage heartfailure
This is an excerpt from the full technical report, which is written in Norwegian. The excerpt provides the report’s main messages in English. N0. 14–2013 Health technology assessment (HTA) Title Left ventricular assist device (LVAD) as destination therapy for patients with endstage heartfailure Norwegian title Hjertepumper (LVAD) som varig behandling av pasienter med alvorlig hjertesvikt Institution Norwegian Knowledge Centre for the Health Services (Nasjonalt kunnskapssenter for helsetjenesten) Magne Nylenna, Director Authors Lauvrak,Vigdis, Project leader, Researcher Skår, Åse, Senior Advisor Arentz-Hansen, Helene, Researcher Hamidi, Vida, Health economist Fure, Brynjar, Research manager
ISBN 978-82-8121-640-2 ISSN 1890-1298 Report No. 14 – 2013 Project number Type of report Health Technology Assessment No. of pages 73 (121 incl. attachments) Client The Norwegian Directorate of Health Subject heading Heart Failure; Heart-Assist Devices (MeSH) Citation Lauvrak V, Skår Å, Arentz-Hansen H, Hamidi V, Fure B. Left ventricular assist device (LVAD) as destination therapy for patients with endstage heartfailure. Report from Kunnskapssenteret no. 14−2013. Oslo: Norwegian Knowledge Centre for the Health Services, 2013.
Norwegian Knowledge Centre for the Health Services summarizes and disseminates evidence concerning the effect of treatments, methods, and interventions in health services, in addition to monitoring health service quality. Our goal is to support good decision making in order to provide patients in Norway with the best possible care. The Centre is organized under The Norwegian Directorate for Health, but is scientifically and professionally independent. The Centre has no authority to develop health policy or responsibility to implement policies.
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Norwegian Knowledge Centre for the Health Services Oslo, November 2013
Title: Key messages (English) Left ventricular assist device (LVAD) as destination therapy for patients with endstage heartfailure ------Type of publication: Health technology assessment The Norwegian National Council for Priority Setting in the Health Health technology assessment Care recommended in 2008 that left ventricular assist device (LVAD) (HTA) is a multidisciplinary should be offered to patients only for a limited period of time, for ex- process that summarizes in- formation about the medical, ample while awaiting heart transplantation. This recommendation social, economic and ethical may be reconsidered. We have assessed LVAD as destination therapy. issues related to the use of a In 2008, there was one randomized controlled trial (RCT) comparing health technology in a system- atic, transparent, unbiased, first-generation LVAD with optimal medical treatment. A literature robust manner. Its aim is to search performed in June 2013 provided an RCT from 2009 that com- inform the development of pared second-generation LVAD with first-generation LVAD, a few re- safe, effective health policies cent prospective case series, registry data and two relevant interna- that are patient focused and that seek to achieve best val- tional cost-effectiveness analyses. Our main conclusions are: ue. ------ Compared with optimal medical therapy LVAD can provide ex- Doesn’t answer eve- tended life time and improved quality of life for selected patients rything: with end-stage heart failure. The magnitude of the clinical effect is - Excludes studies that fall uncertain. outside of the inclusion criteria - No recommendations There are no studies comparing LVAD with heart transplantation. ------Publisher: The most common complications associated with LVAD are bleed- Norwegian Knowledge Centre ing, infections, need for pump replacement, stroke and right ven- for the Health Services tricular heart failure. These complications are the major cause of ------death the first two years following pump insertion. Updated:
Last search for studies: The costs of LVAD have been reduced since 2008, but they are still June, 2013. high. International cost-effectiveness analyses are associated with uncertainty. A Norwegian cost-effectiveness analysis has not been ------performed. Peer review: