Research question:

For heart transplantations in adults, the aims of this investigation are to

– present and assess the relationship between the volume of services (VoS) and the quality of treatment outcome (research question 1) and

– present studies examining the effects of specific minimum case volumes introduced into the health care system on the quality of treatment outcome (research question 2).

This is supplemented by a detailed description of the surgical services included and excluded in the studies classified as relevant.

Conclusion:

In total, 3 observational studies were included for the investigation of the relationship between the VoS and the quality of treatment outcome for heart transplantations in adults (research question 1). All 3 studies showed a low informative value of results. In all 3 studies, the VoS was analysed exclusively at the hospital level.

With regard to the outcome category of mortality, a correlation between the VoS and the quality of treatment outcome could be derived for the outcomes of all-cause mortality and intraoperative or perioperative mortality, in each case on the basis of 2 studies. In contrast, for the outcome of adverse effects of therapy in the outcome category of morbidity, no correlation could be identified on the basis of one study. Further outcomes could not be considered due to alack of data.

For heart transplantations in adults, no meaningful studies were identified examining the effects of specific minimum case volumes introduced into the health care system on the quality of treatment outcome (research question 2).

Publisher

Institute for Quality and Efficiency in Health Care

Topic

Relationship between volume of services and quality of treatment outcome for heart transplantations in adults

Commissioning agency

Federal Joint Committee

Commission awarded on

18 April 2019

Internal Commission No.

V19-05

Address of publisher

This report was prepared in collaboration with external experts and underwent an external review.

The responsibility for the contents of the report lies solely with IQWiG.

According to §139b (3) No. 2 of Social Code Book (SGB) V, Statutory Health Insurance, external experts who are involved in the Institute’s research commissions must disclose “all connections to interest groups and contract organizations, particularly in the pharmaceutical and medical devices industries, including details on the type and amount of any remuneration received”. The Institute received the completed Form for disclosure of potential conflicts of interest from each external expert. The information provided was reviewed by a Committee of the Institute specifically established to assess conflicts of interests. The information on conflicts of interest provided by the external experts and external reviewers is presented in Appendix B of the full report. No conflicts of interest were detected that could endanger professional independence with regard to the work on the present commission.

External expert

Sven Martens, Clinic for Heart Surgery, University Hospital Münster, Münster, Germany

External review of the preliminary report

Roman Pfister, Clinic III for Internal Medicine, General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Internal Intensive Care Medicine, University Hospital Cologne, Cologne, Germany

IQWiG thanks the external expert and external reviewer for their collaboration in the project.

IQWiG employees

• Wiebke Hoffmann-Eßer
• Lutz Altenhofen
• Ralf Bender
• Mandy Kromp
• Christoph Mosch
• Dorothea Sow