Cost comparison of heart transplant vs. left ventricular assist device therapy at one year

Abstract

With the worldwide shortage of donor organs, use of ventricular assist device (VAD) therapy is rapidly increasing in both the bridge to transplant and destination therapy settings. However, the high cost of VADs and VAD care is a cause for concern for policy makers who have relied on the limited supply of donor hearts to naturally cap health expenditure on heart transplantation (HTx). We sought to compare costs of the first 12 months of care of VADs vs. HTx. Single center retrospective study utilizing real generated costs over a three yr span from 2010-2012. Only patients with 12 months of costing data were included. Costs of 28 HTx patients and 24 VAD patients were analyzed. Index admission costs were more than double in the VAD group compared to the HTx group and this was driven by the procurement costs and length of stay which increased almost all aspects of in hospital care costs. Subsequent costs were six times higher in the HTx group and this was driven largely by pharmaceuticals. VAD therapy remains a very expensive treatment option for end stage heart failure patients. Device prices need to reduce substantially to make this a more widely applicable and cost effective treatment option.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…There was no difference in survival between patients who were and were not readmitted, although median follow up was only 11 months. 82 …”

Cognition predicts days-alive-out-of-hospital after LVAD implantation

“…8 The cost of hospitalization for LVAD patients cannot be ignored, especially as LVAD implantation rates increase. 4 Examination of the influence of cognition on hospitalization outcomes for HF patients, including those receiving LVADs, may identify methods for improving hospitalization rates and costs.…”

“…Re-hospitalization post-LVAD is common 1-3 and costly. 4 Days alive out of hospital (DAOH), an index of morbidity and quality of life (QOL) for HF patients, is thwarted by these rehospitalizations. [5][6][7][8] Cognition predicts hospitalization rates 9-11 and duration [11][12][13] for a variety of patient groups but has not been used to predict hospitalization in LVAD recipients.…”

Combining Institutional and Administrative Data to Assess Hospital Costs for Patients Receiving Ventricular Assist Devices

“…Most of the recent cost analyses of cf-VAD BTT therapy have focused on comparison with heart transplant over the first year (19;20), while Mishra et al (18) included 3 months of preimplant/transplant costs, and Williams et al (24) considered presurgical days within the implant admission. With increasing evidence to support adverse events as a driver of cost and poor outcomes in VAD patients (3;19), patient selection along with pre- and postoperative management strategies are likely to influence the cost effectiveness of cf-VAD therapy. Examining activity and cost in the preoperative year where high cost decision making occurs, could enhance targeting resources to optimize patient selection and preparation.…”

“…There have been no CEA of cf-VAD therapy using Australian data and, recent stand-alone patient level cost analyses of cf-VAD therapy have focused on comparisons with the costs of heart transplantation, included data from the implanting institutions only, and assess the postoperative year (18)(19)(20). This study focuses on the development of a method to capture costs in the year leading up to and following implant.…”