LAUSR

Recently, there has been a considerable rise in the prevalence of heart failure. As a result, the number of end-stage heart failure patients has increased. While heart transplantation is the most optimal therapy available for these patients, the scarcity of donor organs and the lengthening waiting list have drastically curtailed the number of transplants available. These patients may benefit from left ventricular assist device (LVAD) therapy. LVAD is traditionally used to bridge critical patients to transplantation, but there has been growing debate to consider LVAD for lifelong permanent support termed “destination therapy.” Healthcare systems in countries such as the US and some European countries have started to use LVAD for destination therapy. However, the UK lags in this matter. In the UK, LVADs are only being recommended for bridge-to-transplantation. The Cost-effectiveness of LVAD for DT is considered one of the most important reasons for this practice in the UK. Data from previous studies put the incremental cost-effectiveness ratio (ICER) slightly above £50 000/QALY, which is regarded as cut-off point for interventions in ‘end of life’ care in the UK healthcare system. However, these studies have used clinical data from an older generation of LVAD, which is not used nowadays in the current clinical scenario. In this issue, Schueler et al. have made efforts to update the clinical data regarding the cost-effectiveness of newer generation LVADs and have thus, re-open the debate on whether to consider LVAD as a viable option for DT.