November 19, 2002
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.
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
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?"
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
The average cost
for LVAD treatment was $196,699.
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.
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.
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
"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."
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.