Cost Comparison between Heart Transplantation and Left Ventricular Assist Device Implantation

Background: The increasing number of end-stage heart failure patients along with improvements in technology and a relative donor organ shortage have led to an increased use of left ventricular assist devices (LVAD) as bridge-to-transplants (BTT). Given the current economic emphasis on cost versus patient benefit and outcome, we sought to compare the financial effectiveness of heart transplant (HTX) and LVAD surgeries. Materials and Methods: We retrospectively analyzed our prospectively maintained HTX and LVAD databases from 1/1/2009 to 6/30/ 2013. The patient’s records were cross referenced with institutional financial data. We limited our LVAD cohort to durable (i.e., not temporary) LVADs. We evaluated overall charges, payments received; direct fixed and variable costs as well as LVAD pump charges. We did not analyze indirect costs as to keep our findings applicable to other institutions. Standard statistical methods were utilized. Results: We identified 141 LVAD and 63 HTX surgeries which met the inclusion criteria. Of those, 20 had both surgeries giving final cohorts of 121 LVAD alone, 43 HTX alone, and 20 LVAD followed by heart transplant (LVAD/HTX). Mean charge for LVAD along was $881,586 +/348,975 and for HTX alone was $686,289 +/400,764. For both surgeries in the LVAD/HTX cohort, the mean charge was $1,496,977 +/806,313. There were differences in cost and payment between groups (Table) and these were demonstrable when adjusted for length of stay. There were similar rates of readmissions with a mean of 4.65 per HTX patient and 4.53 per LVAD patient. 1-year survival for HTX was 87.8% and for LVAD, 78%. 3-year survival for HTX was 72.7% and for LVAD 55%. No differences were found between HTX surgery costs or payments. No LVAD cost or charge differences were found between LVAD and LVAD/HTX groups and LVAD cost was $79,581. Mean LVAD net was $74,320 with HTX net of $124,759. Conclusion: In an analysis of the cost effectiveness of HTX and LVAD surgeries, HTX alone appears to be more cost effective even when adjusting for length of stay. BTT patients have less costly implant operations with actual LVAD pump costs accounting for a portion of the decreased revenue. From a fiscal perspective, primary heart transplantation may be the most cost effective approach to managing patients with advanced heart failure. However, the lack of suitable donors for many of these patients clearly highlights the value of LVADs in the armamentarium of advanced heart failure surgical options.