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Hospital charges for conventional therapy versus left ventricular assist system therapy in heart transplant patients
M J Cloy1, T J Myers, L A Stutts
1Cullen Cardiovascular Research Laboratories, Department of Cardiovascular Surgical Research, Texas Heart Institute, Houston 77030, USA.
Insights
Left ventricular assist systems (LVAS) offer reliable mechanical circulatory support. While increasing hospital stay, LVAS therapy significantly reduces daily costs for heart failure patients, potentially saving money long-term.
Area of Science:
- Cardiology
- Biomedical Engineering
- Health Economics
Background:
- Left ventricular assist systems (LVAS) aim for long-term, safe, and cost-effective mechanical circulatory support.
- The Heartmate LVAS has demonstrated reliability in clinical trials as a bridge to transplantation, improving survival rates.
- LVAS implantation can enhance patients' physical status, enabling discharge from intensive care units (ICUs) and reducing overall hospitalization expenses.
Purpose of the Study:
- To analyze and compare hospital charges for heart transplant patients receiving conventional medical therapy versus in-hospital LVAS therapy.
- To evaluate the cost-effectiveness of LVAS support, including a case of home-based LVAS therapy.
Main Methods:
- Retrospective analysis of hospital charges for three patient groups: conventional therapy before transplant (Group 1, n=6), in-hospital LVAS therapy before transplant (Group 2, n=6), and one patient with home LVAS support.
- Comparison of length of hospital stay and daily hospital charges between Group 1 and Group 2.
Main Results:
- Group 1 patients had a mean hospital stay of 51 days with a daily charge of $5,150.
- Group 2 patients had a significantly longer mean hospital stay of 185 days but a lower daily charge of $3,178.
- The patient receiving home LVAS support incurred minimal daily medical expenses ($27/day).
Conclusions:
- Despite longer hospitalizations, in-hospital LVAS therapy results in substantially lower average daily charges compared to conventional medical therapy.
- LVAS support offers potential for improved quality of life and significant cost savings for end-stage heart failure patients, especially if used as an alternative to transplantation.
Abstract:
An important goal of a left ventricular assist system (LVAS) is to provide long-term, safe, cost-effective mechanical circulatory support. The Heartmate LVAS (Thermo Cardiosystems, Inc., Woburn, MA), used in recent clinical trials as a bridge to transplantation, has proven extremely reliable for long periods, and its use has improved the survival rates in patients who subsequently received a donor heart. Patients who have been implanted with an LVAS often have significantly improved physical status and can leave the intensive care unit (ICU) and be treated at less expense elsewhere in the hospital. In this preliminary report, the authors analyzed hospital charges for three groups of patients: heart transplant patients who received conventional medical therapy before transplantation (Group 1), transplant patients who received in-hospital LVAS therapy (Group 2), and one patient who awaited transplantation at home while undergoing LVAS support. Group 1 patients (n = 6) received intraaortic balloon pump (IABP) support and inotropic therapy in an ICU before transplantation. Group 2 (n = 6) patients were receiving IABP support and inotropic therapy when the LVAS was implanted and eventually underwent heart transplantation. The length of hospital stay in Group 1 (51 days) was significantly shorter than in Group 2 (185 days). Mean hospital charge in Group 1 was $5,150/day; in Group 2, $3,178/day. The patient living at home incurred an average medical expense of $27/day. Although LVAS supported patients remain in the hospital much longer than do medically treated patients, their average daily in-hospital charges are much less. If the LVAS could be used as an alternative to transplantation, it might offer not only a longer, better quality life, but also a potential cost savings to patients with end-stage heart failure.