OBJECTIVES: End-stage heart failure is a leading cause of death; patients have a poor prognosis and low quality of life.  Managing the limiting and distressing symptoms places significant costs on the NHS.  Therapy options are few; primarily combination medical therapy and, for a few patients, transplantation using a donor heart.  Left ventricular assist devices (LVADs) are mechanical pumps that support the heart function.  Use is increasing worldwide as more studies demonstrate clinical effectiveness, primarily from improved patient survival and quality of life.  However, there are no published cost effectiveness studies.  This pilot evaluates the cost effectiveness of the HeartWare LVAD as destination therapy for patients with end-stage heart failure. METHODS: A cost-utility model compared the outcomes and costs of patients who were medically managed without a transplant (n=15) with those who received a HeartWare LVAD and no subsequent transplant (n=17).  Clinical data were from a multicentre trial evaluating the safety and efficacy of the HeartWare LVAD [1] and outcomes for patients listed on the NHS Blood and Transplant Registry [2].  Utility values were from a Health Technology Assessment [3] and derived using the EQ-5D tool.  Cost data came mainly from published sources. RESULTS: The results from this evaluation were patients managed with the HeartWare device had higher costs but better outcomes than those who were medically managed.  At 5 years the additional cost was about £20,500 per patient and a QALY gain of 1.05, giving an incremental cost per QALY of under £20,000, below the threshold commonly adopted of £25,000 per QALY.  CONCLUSIONS: The results are encouraging and suggest it is plausible that using LVADs as long-term support in patients with end-stage heart failure could be a cost-effective use of healthcare provider resources.  Further research is needed to refine the clinical and cost data.