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Heart transplantation versus continuous-flow left ventricular assist device: comprehensive cost at 1 year
Snehal R Patel1, Alan Sileo2, Ricardo Bello3
1Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Insights
The 1-year cost of continuous-flow left ventricular assist devices (CF-LVAD) is similar to heart transplantation (HT), exceeding $369,000. Reducing postoperative hospital stay may lower these high costs for advanced heart failure therapies.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Medical Technology Assessment
Background:
- Understanding the economic impact of advanced heart failure treatments is crucial amid healthcare reform.
- Continuous-flow left ventricular assist devices (CF-LVAD) represent a newer technology compared to established heart transplantation (HT).
- Limited data exists on the comparative costs of CF-LVAD and HT beyond the first year of support.
Purpose of the Study:
- To compare the total direct and indirect costs associated with CF-LVAD support versus HT over the first year post-procedure.
- To identify key cost drivers within the first 365 days for both CF-LVAD and HT recipients.
Main Methods:
- A cohort study included 20 patients receiving CF-LVAD and 20 patients undergoing HT, all surviving at least one year.
- Comprehensive cost data was collected from the day of operation through 365 days, adjusted for inflation to 2010 US dollars.
- Hospital charges were converted to costs using specific cost-to-charge ratios and analyzed by time segment and cost center.
Main Results:
- The total 1-year cost for CF-LVAD recipients was $369,519 (IQR $321,020-$520,395), compared to $329,648 (IQR $278,924-$395,456) for HT recipients, a difference not statistically significant (P = .242).
- The initial hospital admission accounted for over 50% of the total 1-year costs in both groups.
- Major cost centers included organ/device acquisition, room and board, and professional fees for both treatment modalities.
Conclusions:
- Patients surviving one year on CF-LVAD support incur costs comparable to those of heart transplantation recipients.
- The overall 1-year cost for both advanced therapies remains substantial, exceeding one-third of a million dollars.
- Reducing the postoperative length of stay presents a significant opportunity for cost reduction in CF-LVAD therapy.
Background:
With health care reform firmly on the horizon, it is critical to understand the costs associated with new technologies such as continuous-flow left ventricular assist device (CF-LVAD) compared with well established treatments such as heart transplantation (HT). Scarce data exist describing the costs of these 2 therapies after 1 year of support.
Methods And Results:
The study population consisted of 20 consecutive subjects who underwent implantation of a CF-LVAD and 20 consecutive subjects who underwent HT and survived ≥1 year. Comprehensive cost calculation included all direct and indirect costs from day of operation through 365 days and were inflation adjusted to 2010 US dollars. Hospital charges were converted to costs with the use of hospital-specific cost-to-charge ratios and were analyzed by time segment as well as cost center. The total 1-year cost was higher in the CF-LVAD group, although this difference did not reach statistical significance ($369,519 [interquartile range [IQR] $321,020-$520,395] vs $329,648 [IQR $278,924-$395,456]; P = .242). In both groups, the index admission constituted >50% of the total 1-year cost and the major drivers of expense by cost center were organ/device acquisition, room and board, and professional fees.
Conclusions:
Patients surviving to 1 year on CF-LVAD support accrued costs similar to those of HT recipients; however, the total cost, at more than one-third of a million dollars, remains high. Reduction in the postoperative length of stay offers an avenue for significant cost savings.
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