Moskowitz A J, Rose E A, Gelijns A C
International Center for Health Outcomes and Innovation Research, Department of Surgery, College of Physicians and Surgeons, The Joseph L Mailman School of Public Health, Columbia University, New York, New York 10032, USA.
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S195-8; discussion S203-4. doi: 10.1016/s0003-4975(00)02621-7.
With increasing use of left ventricular assist devices (LVAD) worldwide, the economics of LVAD implantation have become an important focus of concern. Although these devices have high unit costs, they are the only hope for survival for a large group of terminally ill patients and are likely to have an expansion in indications for use.
We calculated the costs associated with long-term LVAD implantation. We used the ratio of cost-to-charges method to calculate hospital costs per resource category, market prices for drugs and device, and payments for physician services.
Based on our experience with "bridge-to-transplantation" patients, we estimated average first-year costs to be $222,460 including professional fees and $192,154 excluding professional fees. The latter figure is comparable to average first-year costs for cardiac transplantation, which is $176,605 without professional fees at our institution.
The costs of LVAD therapy will change after the first year of implantation, and device reliability and longevity will be important factors in determining these costs. Should the costs of LVAD therapy continue to track those of cardiac transplantation, devices will be cost-effective only if they offer similar efficacy to cardiac transplantation.
随着全球范围内左心室辅助装置（LVAD）使用的增加，LVAD植入的经济学已成为重要的关注焦点。尽管这些装置单位成本高昂，但它们是一大群晚期患者生存的唯一希望，并且其使用适应症可能会扩大。
我们计算了长期LVAD植入相关的成本。我们使用成本与收费比率法来计算每个资源类别的医院成本、药品和装置的市场价格以及医生服务费用。
基于我们对“过渡到移植”患者的经验，我们估计包括专业费用在内的第一年平均成本为222,460美元，不包括专业费用的为192,154美元。后一个数字与心脏移植的第一年平均成本相当，在我们机构，心脏移植不包括专业费用的平均第一年成本为176,605美元。
LVAD治疗的成本在植入后的第一年之后会发生变化，装置的可靠性和使用寿命将是决定这些成本的重要因素。如果LVAD治疗的成本继续与心脏移植的成本相当，那么只有当这些装置提供与心脏移植相似的疗效时，它们才具有成本效益。
