title: Cardiac replacement therapies: outcomes and costs for heart transplantation versus circulatory assist.
abstract: OBJECTIVE
  Growing number of patients with terminal heart failure and a shortage of heart donors have increased use of short- and long-term mechanical circulatory support (MCS). Few studies have analyzed survival rates and healthcare costs for heart transplantation (HTx), with or without extracorporeal membrane oxygenation (ECMO) and left ventricular assist device (LVAD).
  
  
  METHODS
  In a retrospective, single-center study, data were analyzed from patients listed for HTx who died on the waiting list (DWL, n = 12), underwent HTx (n = 206), had ECMO as bridge to HTx (ECHTx, n = 15), or received LVAD treatment, either isolated (LVAD, n = 19) or bridging to HTx (LVADHTx, n = 26) during 2005-2012. Survival and hospital costs were assessed.
  
  
  RESULTS
  One- and five-year survival rates were 96% and 83% for the LVADHTx group, 92% and 81% for HTx, 70% and 70% for ECHTx, 48% and 36% for LVAD and 0% for the DWL group (overall survival, p < 0.001). Total hospital cost at one year was $102,101 ± 202,604 for DWL, $151,685 ± 86,892 for HTx, $292,078 ± 101,915 for ECHTx, $427,337 ± 365,154 for LVAD, and $600,897 ± 198,109 for LVADHTx.
  
  
  CONCLUSIONS
  The LVADHTx and HTx groups showed excellent one- and five-year survival. The combined group of DWL and HTx patients had similar survival to the combined groups of MCS, but use of LVAD pre-transplant quadrupled the cost.
authors.affiliation: a Department of Finance and Resource Management Unit , Oslo University Hospital , Oslo , Norway.|b Department of Health Management and Health Economics, Faculty of Medicine , University of Oslo , Oslo , Norway.
authors.forename: Vinod
authors.initials: V
authors.lastname: Mishra
authors.affiliation: c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway.|d Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors.forename: Arnt Eltvedt
authors.initials: AE
authors.lastname: Fiane
authors.affiliation: a Department of Finance and Resource Management Unit , Oslo University Hospital , Oslo , Norway.
authors.forename: Benny Adam
authors.initials: BA
authors.lastname: Winsnes
authors.affiliation: c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway.|d Faculty of Medicine , Institute of Clinical Medicine, University of Oslo , Oslo , Norway.
authors.forename: Odd
authors.initials: O
authors.lastname: Geiran
authors.affiliation: c Department of Cardiothoracic Surgery , Oslo University Hospital , Oslo , Norway.
authors.forename: Gro
authors.initials: G
authors.lastname: Sørensen
authors.affiliation: b Department of Health Management and Health Economics, Faculty of Medicine , University of Oslo , Oslo , Norway.
authors.forename: Terje Per
authors.initials: TP
authors.lastname: Hagen
authors.affiliation: e Department of Cardiology , Oslo University Hospital , Oslo , Norway.
authors.forename: Einar
authors.initials: E
authors.lastname: Gude
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009664:Norway; D017064:Process Assessment, Health Care / Q000191:economics*; D011474:Prosthesis Design; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: Cost; LVAD; heart transplantation; left ventricular assist device; mortality; survival