title: The artificial heart. Costs, risks, and benefits--an update.
abstract: As discussed above, approximately 32,500 persons aged 55 to 70 years with end-stage heart disease may be potential candidates for the artificial heart each year. However, continued application of a protocol that requires informed consent by the patient effectively limits the pool to 12,000 annually. Estimates of the cost of the artificial heart include charges for the surgical procedure, device and console, and continuing medical surveillance. These estimates range from a low of $100,000 to a high of $300,000 per patient in the initial year. Assuming a five-year, 51% survival and an initial cost of $100,000, total program costs in the fifth year are projected to be $1.3 billion for a pool of 12,000 patients, and $3.8 billion for 32,500 patients. These projected costs are associated with anticipated increases in life expectancy. For those individuals destined to develop heart disease, the anticipated average increase is approximately half a year. In comparison, heart transplant patients who meet the surgical criteria but who do not receive a new heart do not survival beyond six months. In an era of limited resources, it is imperative that such a potentially expensive innovation as the artificial heart be compared carefully with other social and medical programs designed to extend life and improve its quality. Such a comparison will require a full understanding of the likely costs and benefits of the device. A viable artificial heart would greatly alter current treatment for end-stage cardiac disease. More patients would benefit from this therapy than currently benefit from heart transplants, and the costs of caring for these patients would increase substantially. The current state of development of the artificial heart provides an opportunity to collect data on investigational artificial heart performance, clinical results, patient status, and economic and social costs. This knowledge base would be invaluable for future technology assessments and policy decisions regarding third party reimbursement. Insofar as we may be faced with a multi-billion dollar annual investment in the future, detailed assessments of the artificial heart should be performed.
mesh_terms: D003362:Cost-Benefit Analysis; D006354:Heart, Artificial / Q000191:economics*; D006801:Humans; D013223:Statistics as Topic; D013673:Technology Assessment, Biomedical; D014481:United States