Comparative costs of home positive inotropic infusion versus in-hospital care in patients awaiting cardiac transplantation.
BACKGROUND
Outpatient positive inotropic support combined with implantation of an automatic implantable cardioverter defibrillator (AICD) may be used as a successful bridge to cardiac transplantation in patients with end-stage heart failure. A detailed comparative cost analysis of this outpatient strategy versus in-hospital care has not been previously reported.


RESULTS
Twenty-one United Network for Organ Sharing 1B patients awaiting cardiac transplantation received continuous outpatient inotropic therapy for a total of 3070 patient-days. Daily costs for outpatient and in-hospital treatment were calculated. Nonparametric decision analysis was used to determine the strategy with greatest cost savings (immediate hospital discharge after AICD implantation versus in-hospital care). A threshold analysis was performed to test the robustness of the decision analysis model. The outpatient strategy realized an average savings of $71,300 to $120,500 per patient. Decision analysis showed that no fixed period of in-hospital monitoring was more cost-saving than immediate hospital discharge after AICD implantation. Threshold analysis revealed that AICD costs would need to exceed $82,000 (currently $62,000) or that the difference between the outpatient and the in-hospital costs would need to be < or = $475 per day for any other intermediate strategy to be considered cost-saving.


CONCLUSIONS
Outpatient inotropic therapy combined with AICD implantation in selected patients awaiting cardiac transplantation is an effective cost-minimizing strategy.
Yale University School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut 06510, USA.
Shrikanth P Y
SP
Upadya
Artyom
A
Sedrakyan
Clara
C
Saldarriaga
Karin
K
Nystrom
Janis
J
Bozzo
Forrester A
FA
Lee
Stuart D
SD
Katz
D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000191:economics; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D016027:Heart Transplantation; D018718:Home Infusion Therapy / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D017063:Outcome Assessment, Health Care
D002316:Cardiotonic Agents