Left ventricular assist devices as permanent heart failure therapy: the price of progress.
BACKGROUND
The REMATCH trial evaluated the efficacy and safety of long-term left ventricular assist device (LVAD) support in stage D chronic end-stage heart failure patients. Compared with optimal medical management, LVAD implantation significantly improved the survival and quality of life of these terminally ill patients. To date, however, there have been no analyses of the cost related to the LVAD survival benefit. This paper addresses the cost of hospital resource use, and its predictors, for long-term LVAD patients.


METHODS
Detailed cost data were available for 52 of 68 REMATCH patients randomized to LVAD therapy. We combined the clinical dataset with Medicare data, standard billing forms (UB-92), and line item bills provided directly by clinical centers. Charges were converted to costs by using the Ratio-of-Cost-to-Charges for each major resource category.


RESULTS
The mean cost for the initial implant-related hospitalization was $210,187 +/- 193,295. When implantation hospitalization costs are compared between hospital survivors and nonsurvivors, the mean costs increase from $159,271 +/- 106,423 to $315,015 +/- 278,713. Sepsis, pump housing infection, and perioperative bleeding are the major drivers of implantation cost, established by regression modeling. In the patients who survived the procedure (n = 35), bypass time, perioperative bleeding, and late bleeding were the drivers of cost. The average annual readmission cost per patient for the overall cohort was $105,326.


CONCLUSIONS
The cost of long-term LVAD implantation is commensurate with other life-saving organ transplantation procedures like liver transplantation. As an evolving technology, there are a number of opportunities for improvement that will likely reduce costs in the future.
Oz
Mehmet C
MC
International Center for Health Outcomes and Innovation Research and the Department of Surgery, Columbia University, New York, NY 10032, USA.
Gelijns
Annetine C
AC
Miller
Leslie
L
Wang
Cuiling
C
Nickens
Patrice
P
Arons
Raymond
R
Aaronson
Keith
K
Richenbacher
Wayne
W
van Meter
Clifford
C
Nelson
Karl
K
Weinberg
Alan
A
Watson
John
J
Rose
Eric A
EA
Moskowitz
Alan J
AJ
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D018579:Patient Selection; D014481:United States