title: Cost of 1-year left ventricular assist device destination therapy in chronic heart failure: a comparison with heart transplantation.
abstract: OBJECTIVE
  To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation.
  
  
  METHODS
  Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (n = 6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (n = 19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (n = 13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (64±8 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation.
  
  
  RESULTS
  One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was €85 531±19 823 for HTX, €125 108±32 399 for bridging, and €137 068±29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was €138 076±19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is €42 153 for HTX, €53 637 for transplantation including the bridging cost, and €47 487 for DT.
  
  
  CONCLUSIONS
  Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.
authors.forename: W
authors.initials: W
authors.lastname: Droogne
authors.forename: S
authors.initials: S
authors.lastname: Jacobs
authors.forename: K
authors.initials: K
authors.lastname: Van den Bossche
authors.forename: J
authors.initials: J
authors.lastname: Verhoeven
authors.forename: R R
authors.initials: RR
authors.lastname: Bostic
authors.forename: J
authors.initials: J
authors.lastname: Vanhaecke
authors.forename: J
authors.initials: J
authors.lastname: Van Cleemput
authors.forename: F
authors.initials: F
authors.lastname: Rega
authors.forename: B
authors.initials: B
authors.lastname: Meyns
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000191:economics* / Q000628:therapy*; D016027:Heart Transplantation / Q000191:economics*; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cost,; Destination therapy,; Heart transplantation; VAD,