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The artificial heart. Costs, risks, and benefits--an update
Insights
The artificial heart offers potential life extension for end-stage heart disease patients, but high costs necessitate careful evaluation against other life-saving medical programs.
Area of Science:
- Biomedical Engineering
- Health Economics
- Cardiology
Background:
- End-stage heart disease affects a significant population, with many potentially eligible for artificial heart devices.
- Current artificial heart protocols limit eligible candidates due to informed consent requirements.
- Artificial heart technology presents a substantial advancement in treating advanced cardiac conditions.
Purpose of the Study:
- To assess the potential costs and benefits of artificial heart implantation.
- To compare the artificial heart's impact on life expectancy and resource allocation with existing medical interventions.
- To highlight the need for comprehensive data collection on artificial heart performance and associated costs.
Main Methods:
- Estimating the number of potential artificial heart candidates annually.
- Calculating projected costs for the artificial heart, including surgery, device, and ongoing care.
- Analyzing survival rates and life expectancy increases associated with the artificial heart.
- Comparing artificial heart therapy with heart transplantation and other life-extending programs.
Main Results:
- Approximately 32,500 individuals annually are potential candidates, limited to 12,000 by current consent protocols.
- Initial artificial heart costs range from $100,000 to $300,000 per patient.
- Projected fifth-year program costs range from $1.3 billion to $3.8 billion.
- Artificial heart recipients may gain an average of half a year in life expectancy.
Conclusions:
- Artificial heart implantation could significantly increase healthcare costs for end-stage heart disease.
- Careful economic and social assessment is crucial for this expensive innovation.
- Data collection on artificial heart performance and costs is vital for future policy and reimbursement decisions.
Abstract:
As discussed above, approximately 32,500 persons aged 55 to 70 years with end-stage heart disease may be potential candidates for the artificial heart each year. However, continued application of a protocol that requires informed consent by the patient effectively limits the pool to 12,000 annually. Estimates of the cost of the artificial heart include charges for the surgical procedure, device and console, and continuing medical surveillance. These estimates range from a low of $100,000 to a high of $300,000 per patient in the initial year. Assuming a five-year, 51% survival and an initial cost of $100,000, total program costs in the fifth year are projected to be $1.3 billion for a pool of 12,000 patients, and $3.8 billion for 32,500 patients. These projected costs are associated with anticipated increases in life expectancy. For those individuals destined to develop heart disease, the anticipated average increase is approximately half a year. In comparison, heart transplant patients who meet the surgical criteria but who do not receive a new heart do not survival beyond six months. In an era of limited resources, it is imperative that such a potentially expensive innovation as the artificial heart be compared carefully with other social and medical programs designed to extend life and improve its quality. Such a comparison will require a full understanding of the likely costs and benefits of the device. A viable artificial heart would greatly alter current treatment for end-stage cardiac disease. More patients would benefit from this therapy than currently benefit from heart transplants, and the costs of caring for these patients would increase substantially. The current state of development of the artificial heart provides an opportunity to collect data on investigational artificial heart performance, clinical results, patient status, and economic and social costs. This knowledge base would be invaluable for future technology assessments and policy decisions regarding third party reimbursement. Insofar as we may be faced with a multi-billion dollar annual investment in the future, detailed assessments of the artificial heart should be performed.