title: The In-Hospital Cost of Ventricular Assist Device Therapy: Implications for Patient Selection.
abstract: Ventricular assist device (VAD) therapy is increasingly utilized to support patients in end-stage heart failure. However, VAD programs are resource intensive and demand active monitoring to ensure long-term sustainability. The purpose of this study was to analyze total cost trends of the VAD program at our academic medical center. Retrospective analysis of University of California - Los Angeles's VAD program between 2013 and 2014 was performed. Total in-hospital costs from the date of VAD surgery admission were queried and normalized to a z score. Multivariable linear regression analysis with step-wise elimination was used to model total costs. Overall, 42 patients received a VAD during the study period, with 19 (45%) receiving biventricular support. On univariate analysis, high body mass index, biventricular support, time between VAD implantation and discharge, and total length of hospital stay were correlated with higher costs (all p < 0.02). On multivariable analysis, time between VAD implantation and discharge and biventricular support remained significantly related to total costs (overall R = 0.831, p < 0.001). The time between VAD implantation and discharge and the use of biventricular support were the most predictive factors of total cost in our VAD population. Reducing hospital stay post-VAD implantation is important in minimizing the cost of VAD care.
authors.affiliation: From the *David Geffen School of Medicine, UCLA Medical Center, Los Angeles, California; and †Division of Cardiac Surgery, UCLA Medical Center, Los Angeles, California.
authors.forename: Amit
authors.initials: A
authors.lastname: Iyengar
authors.forename: Oh Jin
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Msgana
authors.initials: M
authors.lastname: Tamrat
authors.forename: Anthony
authors.initials: A
authors.lastname: Salimbangon
authors.forename: Nancy
authors.initials: N
authors.lastname: Satou
authors.forename: Peyman
authors.initials: P
authors.lastname: Benharash
authors.forename: Abbas
authors.initials: A
authors.lastname: Ardehali
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shemin
authors.forename: Murray H
authors.initials: MH
authors.lastname: Kwon
mesh_terms: D005260:Female; D006333:Heart Failure / Q000191:economics* / Q000601:surgery*; D006353:Heart-Assist Devices / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome