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Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study
Roslyn Prichard1, Louise Kershaw2, Stephen Goodall3
1Faculty of Health, University of Technology Sydney, NSW, Australia.
Insights
Left ventricular assist device (VAD) implantation stabilizes hospital costs for heart transplant candidates. However, significant pre-VAD costs occur outside the implanting center, impacting economic models.
Area of Science:
- Cardiology
- Transplant Surgery
- Health Economics
Background:
- Up to 50% of heart transplant candidates require mechanical circulatory support via left ventricular assist devices (VADs).
- Understanding the economic impact of VADs is crucial for healthcare resource allocation.
Purpose of the Study:
- To analyze hospital activity and costs in the year preceding and following VAD implantation (pre-VAD).
- To compare these costs with those incurred in the year prior to heart transplantation (pre-HTX).
- To investigate costs using both institutional and linked administrative data in an Australian cohort.
Main Methods:
- Retrospective analysis of 77 consecutive patients listed for heart transplant (2009-2012).
- Cost data sourced from institutional records and Australian Refined Diagnosis Related Groups (arDRGs).
- Comparison of total and per-day costs for 25 VAD recipients and 52 pre-transplant patients.
Main Results:
- VAD implantation accounted for 50% of pre-VAD year hospital costs.
- A significant portion of costs (64% pre-HTX, 38% pre-VAD) occurred outside the implanting center.
- Pre-VAD year costs ($97,565) were significantly higher than pre-HTX year costs ($40,250).
Conclusions:
- VAD implantation stabilizes hospital costs for patients discharged home.
- A substantial proportion of pre-implant costs are incurred at non-implanting centers.
- Economic models evaluating VAD impact must account for these distributed costs.
Background:
Up to 50% of heart transplant candidates require bridging with left ventricular assist devices (VAD). This study describes hospital activity and cost 1 year preceding and 1 year following VAD implant (pre-VAD) and for the year before transplant (pre-HTX). The sample comprises an Australian cohort and is the first study to investigate costs using both institutional and linked administrative data.
Methods:
Institutional activity was established for 77 consecutive patients actively listed for transplant between 2009 and 2012. Costs were sourced from the institution or Australian refined diagnosis groups (arDRGs) and the National Efficient Price for admissions to other public and private institutions. Data from 25/77 VAD recipients were analysed and compared with data from 52/77 pre-transplant patients. Total and per day at risk costs were assessed, as well as totals per resource.
Results:
Fifty per cent (50%) of the hospital costs in the pre-VAD year occurred during admission of VAD implant. Sixty-four per cent (64%) of costs in the pre-HTX and 38% in the pre-VAD period occurred outside the implanting centre. Costs in the year prior to VAD, $97,565 (IQR $86,907-$153,916), were significantly higher than costs accrued in the year prior to transplant, $40,250 ($13,493-$81,260), p < 0.0001. Once discharged, costs per day at risk for post-VAD patients approximated those from the pre-admission period, p = 0.16 and in the more clinically stable pre-HTX cohort, p = 0.08.
Conclusion:
Compared with the year prior, VAD implant stabilised hospital cost in patients discharged home. A high proportion of the hospital costs in the pre-implant year occur outside the implanting centre and should be considered in economic models assessing the impact of VAD implant.
