The cost of long-term LVAD implantation.
BACKGROUND
With increasing use of left ventricular assist devices (LVAD) worldwide, the economics of LVAD implantation have become an important focus of concern. Although these devices have high unit costs, they are the only hope for survival for a large group of terminally ill patients and are likely to have an expansion in indications for use.


METHODS
We calculated the costs associated with long-term LVAD implantation. We used the ratio of cost-to-charges method to calculate hospital costs per resource category, market prices for drugs and device, and payments for physician services.


RESULTS
Based on our experience with "bridge-to-transplantation" patients, we estimated average first-year costs to be $222,460 including professional fees and $192,154 excluding professional fees. The latter figure is comparable to average first-year costs for cardiac transplantation, which is $176,605 without professional fees at our institution.


CONCLUSIONS
The costs of LVAD therapy will change after the first year of implantation, and device reliability and longevity will be important factors in determining these costs. Should the costs of LVAD therapy continue to track those of cardiac transplantation, devices will be cost-effective only if they offer similar efficacy to cardiac transplantation.
Moskowitz
A J
AJ
International Center for Health Outcomes and Innovation Research, Department of Surgery, College of Physicians and Surgeons, The Joseph L Mailman School of Public Health, Columbia University, New York, New York 10032, USA. ajm4@columbia.edu
Rose
E A
EA
Gelijns
A C
AC
D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006333:Heart Failure / Q000191:economics / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010359:Patient Readmission / Q000191:economics; D019919:Prosthesis Implantation / Q000191:economics*; D013997:Time Factors