Evans R W
Prog Cardiovasc Dis. 2000 Jul-Aug;43(1):81-94. doi: 10.1053/pcad.2000.7201.
In contrast to heart transplantation, little effort has been made to estimate the economic implications of mechanical cardiac assistance from either a procedure- or a program-level perspective. With annual direct and indirect expenditures for the treatment of coronary artery disease and congestive heart failure now exceeding $65 billion in the United States, and the treatment options available for these diseases becoming increasingly diverse, it is important that we begin to better understand how expenditures for various treatment options compare. From a disease management perspective, it is also essential that policymakers have credible estimates of total program expenditures. At this time, program expenditures for heart transplantation in the United States are somewhere between $352 and $700 million. Given the availability of viable long-term mechanical cardiac assistance and the current need for cardiac replacement, total direct annual program expenditures could be as low as $5.4 billion or as high as $24 billion, depending on the expenses associated with device implantation and maintenance. By contrast, in 1996 the United States spent $9.8 billion on the treatment of end-stage renal disease. Clearly, the economics are such that viable mechanical cardiac assistance will likely engender considerable public policy debate.
与心脏移植不同，从手术层面或项目层面的角度来评估机械心脏辅助的经济影响所做的工作很少。在美国，目前用于治疗冠状动脉疾病和充血性心力衰竭的年度直接和间接支出超过650亿美元，而且这些疾病的治疗选择越来越多样化，因此我们开始更好地了解各种治疗选择的费用比较情况非常重要。从疾病管理的角度来看，政策制定者能够获得可靠的项目总支出估计数也至关重要。目前，美国心脏移植的项目支出在3.52亿至7亿美元之间。鉴于有可行的长期机械心脏辅助手段以及当前对心脏替代的需求，年度项目直接总支出可能低至54亿美元，也可能高达240亿美元，这取决于与设备植入和维护相关的费用。相比之下，1996年美国在终末期肾病治疗上花费了98亿美元。显然，从经济学角度来看，可行的机械心脏辅助很可能引发大量的公共政策辩论。
