Cardiac replacement therapies: outcomes and costs for heart transplantation versus circulatory assist

Mishra, Vinod; Fiane, Arnt E.; Winsnes, Benny Adam; Geiran, Odd; Sørensen, Gro; Hagen, Terje P.; Gude, Einar

doi:10.1080/14017431.2016.1196826

Cited by 18 publications

(22 citation statements)

References 22 publications

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“…In-hospital mortality was found to be significantly higher for HTx waiting list patients compared to BTT LVAD patients (42.3% vs. 4.3%, P=0.002). Although almost all of the included studies, similarly to our overall results, did not find statistically significant differences in 1-year mortality between DT LVAD and HTx patients, Mishra et al found that DT LVAD patients had inferior short term survival comparing to HTx (17). However, this study was limited by its small size.…”

Section: Discussioncontrasting

confidence: 40%

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Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: The optimal treatment for advanced heart failure (HF) patients with regards to mortality remains unknown. Heart transplantation (HTx) and left ventricular assist devices (LVAD) used either as a bridge to transplant (BTT) or destination therapy (DT) have been compared in a number of studies, without definite conclusions with regards to mortality benefit. We sought to systematically review the pertinent literature and perform a meta-analysis of all the available studies presenting head-to-head comparisons between HTx and LVAD BTT or LVAD DT for late (>6 months) all-cause mortality.Methods: We performed a systematic search of Medline and Cochrane Central databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a meta-analysis of late mortality comparing HTx vs. BTT LVAD and HTx vs. DT LVAD using a random effects model.Results: Eight studies were included in our meta-analysis, reporting data on 7,957 patients in total.Although the available studies are of high quality [8 stars in Newcastle-Ottawa Scale (NOS) on average], there is paucity of mortality data. Specifically, seven studies compared HTx with BTT and five studies compared HTx with DT for 1-year mortality. Our pooled estimates showed that there was no difference in late mortality among these strategies. Conclusions:Our meta-analysis highlights the small number and the heterogeneity of available studies referring to the optimal invasive management of advanced HF, and shows that there are no differences between HTx and LVAD for these patients with regards to late mortality.

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Section: Discussioncontrasting

confidence: 40%

“…After removal of duplicates, we assess for eligibility 2,849 studies. We excluded 2,809 studies based on their title and abstract and 40 articles were retrieved for full-text review, before resulting in the eight eligible studies (11)(12)(13)(14)(15)(16)(17)(18). The detailed flow diagram is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Theochari¹,

Michalopoulos²,

Oikonomou³

et al. 2018

Ann. Cardiothorac. Surg.

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“…To improve organ utility, there has been the implementation of expanded criteria, and a call for the development of a cardiac allocation score, 5,6 as well as the implementation of the October 2018 UNOS heart transplantation policy changes 7 . With improved technology, we have seen that many patients today have been successfully bridged to OHTx with durable ventricular assist devices with 1 year survival of 96% and 5 year survival of 83% 8 . During the study period, 30% of our OHTx had an LVAD in place.…”

Section: Discussionmentioning

confidence: 99%

“…Heart failure is a huge financial burden, accounting for more than $30 billion in the US alone in 2007 3 . Mishra et al 8 found that total the total hospital costs at 1 year in patients that died on the waiting list was $102 101 ± 202 604, $151 685 ± 86 892 for OHTx, $427 337 ± 365 154 for LVAD, and $600 897 ± 198 109 for OHTx following LVAD. From 2005 to 2009, the mean cost per patient increased for both LVAD and OHTx, 17%, and 40%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…While most durable mechanical support therapies failed to be cost‐effective, OHTx remained cost‐effective when accounting for standard accepted quality‐adjusted life year. In patients where therapies were combined, the use of LVAD as a bridge to OHTx quadrupled the costs 8 . Another driving force in the economics of US healthcare is the disparity of actual hospital collections of hospital charges, which are made to cover hospital costs.…”

Section: Discussionmentioning

confidence: 99%

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Utilizing the index for mortality prediction after cardiac transplantation risk score to predict hospital resource consumption

et al. 2020

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Objective The index for mortality prediction after cardiac transplantation (IMPACT) risk score incorporates 12 preoperative recipient‐specific variables, and has been validated as an accurate predictor of short‐ and long‐term mortality after orthotopic heart transplantation (OHTx). We believe it can also be used to predict hospital costs, and we hypothesize that higher preoperative IMPACT risk scores are associated with increased hospital resource consumption. Methods All OHTx patients ≥18 years of age at our institution were reviewed from 1 January 2000 to 31 December 2014. Total index hospitalization costs post‐transplant were extracted and presented in 2014 consumer price index inflation‐adjusted US dollars. Patients were stratified into quartiles (Q) according to IMPACT risk scores. Logarithmic transformation normalized cost data, and linear regression assessed for correlation. A comparison of cost between Q of IMPACT risk score was performed using rank‐sum and Kruskal‐Wallis tests. Survival was estimated using the Kaplan‐Meier method. Results Three hundred fifty‐six (n = 356) OHTx were performed during the study period. The median IMPACT score for the cohort was five (interquartile range [IQR] 3‐6). Eight (2.2%) patients died within 30‐days and 1‐year Kaplan‐Meier survival was 88.3%. The median length of stay (LOS) was 16 (IQR 14‐24) days. The median hospital cost for index admission was $222 200 (IQR:$169 200‐$313 700). Median LOS was longer in Q4 vs Q1 (18 days vs 15 days, P = .01) and index hospital costs in Q4 were significantly higher compared to Q1 patients ($280 400 vs $205 000, P < .01). There was a significant positive correlation between IMPACT risk score and cost (regression coefficient .04, P < .01). Conclusion This is the first study in adult cardiac transplantation to identify a positive correlation between hospital cost and recipient risk using the IMPACT risk score. Cost and resource consumption for the index admission after OHTx were significantly higher in the highest IMPACT risk Q compared with patients in the lowest Q.

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Extracorporeal Life Support During Perioperative Transplantation

Wan

Guan

2023

Extracorporeal Life Support

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Cardiac replacement therapies: outcomes and costs for heart transplantation versus circulatory assist

Abstract: The LVADHTx and HTx groups showed excellent one- and five-year survival. The combined group of DWL and HTx patients had similar survival to the combined groups of MCS, but use of LVAD pre-transplant quadrupled the cost.

Cited by 18 publications

References 22 publications

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Heart transplantation versus left ventricular assist devices as destination therapy or bridge to transplantation for 1-year mortality: a systematic review and meta-analysis

Utilizing the index for mortality prediction after cardiac transplantation risk score to predict hospital resource consumption

Extracorporeal Life Support During Perioperative Transplantation

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