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Published on: May 11, 2018
Institutional Cost Comparison Between Heart Transplants and Left Ventricular Assist Device Implantations
Neeraj Chimanji1, Arman Kilic, Ayesha Hasan
1From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Insights
Heart transplant and left ventricular assist device (LVAD) costs are similar in the first year. While heart transplants show better survival, LVADs offer a vital option for advanced heart failure patients lacking donors.
Area of Science:
- Cardiovascular Surgery
- Medical Economics
- Heart Failure Management
Background:
- End-stage heart failure patient numbers are rising.
- Left ventricular assist devices (LVADs) are increasingly used as alternatives to heart transplantation.
- Technological advancements have improved LVAD viability.
Purpose of the Study:
- To compare the costs of heart transplantation versus LVAD placement in end-stage heart failure patients.
- To evaluate the economic implications of these advanced therapies in the current healthcare climate.
Main Methods:
- Retrospective analysis of medical records and institutional financial data.
- Comparison of index admission, 1-year readmission, and overall 1-year charges.
- Inclusion of only durable LVADs, excluding temporary devices.
Main Results:
- Index admission costs favored heart transplant ($725,877) over LVAD ($863,433), P=.05.
- One-year survival rates were higher for heart transplant (87.8%) than LVAD (78.0%), P=.04.
- Overall 1-year costs were similar: $927,559 for transplant vs. $1,029,732 for LVAD, P=.49.
Conclusions:
- Heart transplant and LVAD placement demonstrate comparable costs within the first year post-procedure.
- Heart transplantation may offer superior 1-year survival, but LVADs are crucial for patients awaiting donors.
- LVADs represent a valuable surgical option for managing advanced heart failure.
Objectives:
Increased numbers of end-stage heart failure patients and improved technology have led to increased use of left ventricular assist devices as a viable alternative to heart transplants. Given the current economic climate, we compared costs of heart transplant versus device placement.
Materials And Methods:
Medical records of patients who received heart transplants or left ventricular assist devices were cross-referenced with institutional financial data. The device cohort was limited to those receiving durable (not temporary) devices. Index admission, 1-year readmission, and overall 1-year charges were compared using standard statistical methods.
Results:
Of 184 identified patients with end-stage heart failure surgical therapy, 121 received left ventricular assist devices, 43 had heart transplants, and 20 received left ventricular assist devices as bridge to heart transplant; these latter patients were excluded from our analyses. At index admission, mean charges were $863 433 ± $398 427 for device patients and $725 877 ± $488 685 for transplant patients (P = .05). One-year mean readmission rates were similar (4.65/transplant patient and 4.53/device patient; P = .94), with corresponding 1-year survival rates of 87.8% and 78.0% (P = .04). Total readmission charges during year 1 were $169 732 ± $242 366 for device patients and $201 682 ± $297 565 for transplant patients (P = .08), with corresponding overall charges at 1 year of $1 029 732 ± $450 498 and $927 559 ± $562 404 (P = .49).
Conclusions:
During the first year, heart transplant and left ventricular assist device placement have similar costs. Initial index admission costs seem to favor heart transplant, with device pump costs accounting for some of the difference. From a 1-year survival perspective, heart transplant may be more effective; however, with lack of suitable donors, left ventricular assist devices are valuable in the armamentarium of advanced heart failure surgical options.
