Comparison of Costs, Readmissions and Days out of Hospital at One Year between Heart Transplantation and Continuous Flow LVAD

• Published in: The Journal of heart and lung transplantation Vol. 32; no. 4; p. S98
• Main Authors: Goldstein, D.J, Sileo, A, Baker, L, Nguyen, J, Cotter, P
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2013
• Subjects: Surgery
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2013.01.1012

Purpose With healthcare cost reform firmly on the horizon, it is critical to understand costs associated with new technologies like continuous flow LVAD (CFLVAD) vis-s-vis well established treatments for advanced heart failure like heart transplantation (HT). Scarce data exists describing costs of these two therapies after 1 year of support. Methods and Materials 20 consecutive pts who underwent implantation of a CFLVAD and 20 consecutive pts who underwent HT who were discharged following index surgery and survived at least 1 year represent the study populations. All medical costs incl organ acquisition and device costs, and all direct and indirect costs from day of operation through 365 days were calculated. Hospital charges were converted to costs using hospital specific cost-to-charge ratios. Results Total costs for 1 yr are shown in Figure 1 . Median index LOS was 14 and 23 days for HT and LVAD groups respectively(p<0.05). Total of 23 readmissions occurred among 13/20 HT recipients vs 38 readmissions among 17/20 LVAD patients(p<0.05). While most significant cost drivers were organ acquisition and device cost, the major difference in total costs were related to more hospital days and higher cost of surgical supplies in LVAD patients. HT patients enjoyed 355 ±14 days out of hospital vs 348± 29 days for LVAD. It cost $878/day and $1091/day to support a HT and LVAD pt for 1 yr respectively. Conclusions Costs for 1 yr of care are modestly higher for LVAD than for HT patients. Difference attributable to more hospital days and higher surgical costs unrelated to device cost. Reducing index LOS and readmissions for LVAD pts would render these 2 therapies cost equivalent.