ArticleJAMA network open2025
Cost-Effectiveness of Left Ventricular Assist Device for Transplant-Ineligible Patients.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- From innovation to implementation: expanding global access to mechanical circulatory support and heart transplantation.Frontiers in cardiovascular medicine · 2026Review
- Case Report: Transcatheter closure of paravalvular leak following left ventricular assist device and aortic valve replacement.Frontiers in cardiovascular medicine · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Singapore is considering subsidizing left ventricular assist devices (LVADs) for end-stage heart failure (ESHF) and uses cost-effectiveness evidence to inform the determination. Yet, no economic evaluation has thus far been conducted. Objective: To estimate the lifetime cost-effectiveness of LVAD compared with optimal medical management for transplant-ineligible patients. Design, Setting, and Participants: This economic evaluation used a Markov model to simulate survival, stroke incidence, other adverse events, and heart failure hospitalizations for a cohort of adult patients in Singapore with transplant-ineligible ESHF, most of whom were inotrope dependent. Latest LVAD mortality data from a randomized clinical trial were age-adjusted, and an indirect comparison of prior trial results was performed to estimate survival for inotrope-dependent and inotrope-independent patients. Costs were estimated (in 2023 Singapore dollars [SGD]) using cohort billing data from 2017 to 2022 and National Heart Centre Singapore LVAD charges. Statistical analysis was performed from December 2023 to July 2024. Exposure: HeartMate 3 LVAD (Abbott). Main Outcomes and Measures: Health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) evaluated against a threshold of SGD 114 000 (US $85 075) per QALY gained. Results: At model initiation, the cohort had a mean (SD) age of 64 (12) years, and 78% (range, 68%-86%) of patients were inotrope dependent. In the base case analysis, LVAD yielded an additional 3.45 QALYs at an incremental cost of SGD 404 678 (US $301 999), producing an ICER of SGD 117 370 (US $87 590) per QALY gained for the transplant-ineligible population. The ICER differed for inotrope-use subgroups at SGD 106 458 (US $79 446) per QALY gained for inotrope-dependent patients and SGD 174 798 (US $130 446) per QALY gained for inotrope-independent patients (with 59% and 19% probabilities, respectively, of attaining high value). The inotrope-dependent ICER was sensitive to model input changes and structural assumptions, whereas the inotrope-independent ICER consistently exceeded the high-value threshold in scenario analyses. In threshold analyses, a 44% reduction in the total implantation price or a 54% reduction in the all-cause mortality hazard were required for LVAD to be high value for inotrope-independent patients. Confidence that the inotrope-dependent ICER is high value increased to 75% and 85% with respective 20% and 33% reductions in total implantation price. Conclusions and Relevance: In this economic evaluation comparing LVAD with optimal medical management, LVAD was potentially high value for most transplant-ineligible patients who are inotrope dependent. Confidence in this result was improved with plausible price reductions, yet only extreme changes rendered LVAD high value for inotrope-independent patients.
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