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Heart devices, transplants have similar costs; what will we pay?
November 19, 2002
 

CHICAGO, IL (AHA) Implanting lifesaving heart pumps in people with severe congestive heart failure (CHF) costs about the same as heart, liver and other transplants, according to research reported at the American Heart Association's Scientific Sessions 2002.

"This is a landmark study because we can finally answer what it costs to put a left ventricular assist device in place. It is a device that many would consider the ultimate treatment for heart failure, a mechanical alternative to the heart," says lead author Mehmet C. Oz, M.D., director of the Cardiovascular Institute and vice chairman of surgery at Columbia-Presbyterian Medical Center in New York City.

Mechanical heart pumps, known as left-ventricular assist devices (LVADs), can significantly improve survival and the quality of life of patients with end-stage CHF a weakening of the heart muscle that keeps the heart from pumping enough blood for the body's needs.

The new finding poses public policy questions about paying for expensive new devices in light of rising concerns about healthcare costs. "The LVAD has clearly been shown to save lives," Oz says. "But are we, as a society, willing to pay the costs to save these lives?"

The investigators analyzed the medical and cost records of 68 patients who received LVADs during a study called REMATCH. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure was a multicenter trial sponsored by the National Institutes of Health and Thoratec Corporation. They divided the LVAD patients into four groups, or quartiles, according to the cost each person incurred while hospitalized. They didn't include the cost of the LVAD, which is about $65,000.

The average cost for LVAD treatment was $196,699.

The major contributors to hospital costs were time spent in the intensive care unit or a regular hospital bed (39 percent), pharmacy expenses (15 percent), supplies (14 percent) and diagnostic procedures (11 percent).

The time LVAD or organ transplant patients in the middle two quartiles spent in the hospital ranged from 16 to 55 days. These patients represent the type of person most likely to receive an LVAD in the future, say the researchers. Several factors predicted how long patients would stay in the hospital. For example, patients who developed general or device-related infections tended to have longer hospital stays. The infection rate can be reduced, Oz says, which would lower the procedure's cost.

"The major implication of this study is that we have a life-saving technology that is going to be expensive to deliver," he says. "The question we have to address as a society is whether it is worth the expense to put these devices in patients. Our study tells us that these costs are comparable to heart transplantation and liver transplantation ($205,000 and $250,000), which society is already willing to pay for.

"The costs, from my perspective, are less than many would have expected at such an early stage with a device like this," Oz says. "Improving management of these critically ill patients will substantially reduce the costs of this evolving technology."

The patients in REMATCH had the most severe form of CHF. They had also been dependent on heart-stimulating drugs to keep them alive within the prior three months, had a history of hospitalizations for their disease, and were ineligible for a heart transplant because of age, a previous cancer or other conditions unrelated to their heart.

The three-year, randomized trial compared 68 LVAD patients to 61 patients who received the optimal medical care available for CHF. Researchers reported at the American Heart Association's Scientific Sessions last year that the probability of one-year survival for those in the LVAD group was 52 percent vs. 25 percent for patients treated with medication only. Two-year survival rates were 23 percent for those with LVADs and 8 percent for those on medicine only.

"The most common question asked after our report was: What are the costs?" Oz says. "This is the first of a series of documents to explain the costs and get to the root question of whether it is worth it for society to invest money in this technology."

Co-authors are Annetine C. Gelijns, Ph.D.; Alan J. Moskowitz, M.D.; HuiLing Li, M.S.; James W. Long, M.D.; Karl Nelson, M.D.; Wayne E. Richenbacher, M.D.; Raymond R. Arons, Dr.P.H.; Clifford H. VanMeter, M.D.; Mandeep Mehra, Ph.D.; Richard P. Shannon, M.D.; George Magovern Jr., M.D.; and Leslie W. Miller, M.D.


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