Costs associated with ventricular assist device use in children

Ventricular assist devices (VADs) allow children with severe heart failure to be bridged to successful heart transplantation. Ventricular assist devices are being used with increasing frequency in the pediatric population, and newer devices allow even young infants to be supported. Ventricular assist device implantation and maintenance, however, is quite expensive, and the cost-effectiveness of VAD use in adults has been questioned. To date, an economic analysis of VAD support in children has not been undertaken.

We used Pediatric Health Information System, an administrative database of the Child Health Corporation of America (a consortium of Children's Hospitals in North America), to determine the outcomes and costs related to VAD use in children. Data on patients younger than 18 years of age from 2002 to 2007 were reviewed. Hospital charges were converted to costs based on cost-to-charge ratios. Projected survival for subjects who were successfully bridged to heart transplant was derived from published data. The model assumed that if a VAD strategy were not used, the majority of subjects would have required extracorporeal membrane oxygenation support as a bridge to transplantation. Cost-utility was expressed as cost per quality-adjusted life years saved. All future costs and benefits were discounted at 3%.

There were 145 children who underwent VAD implantation at 19 centers in North America. The median age at admission was 8.5 years; the range was newborn to 17.7 years. The median duration of VAD support was 43 days (range, 1 to 465 days). Ninety-four patients (65%) survived to heart transplantation. Thirty-nine (27%) patients died during hospitalization. There were 12 patients (8%) who had VAD explantation and survival to hospital discharge. The mean hospital cost was $624,798. When compared with a strategy of extracorporeal membrane oxygenation support, the calculated cost-utility for VAD as a bridge to transplantation was $119,937 per quality-adjusted life year saved. When key assumptions were changed, the cost-utility varied from $88,304 to $282,320 per quality-adjusted life year saved.

Ventricular assist devices allow an effective bridge to heart transplantation in children. Under base-case assumptions, the cost-effectiveness ratios exceed the threshold of $100,000 per quality-adjusted life year saved. The cost-utility of this strategy, however, is comparable to a number of other life-saving technologies.