Chimanji Neeraj, Kilic Arman, Hasan Ayesha, Higgins Robert S D, Whitson Bryan A, Kilic Ahmet
From the Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Exp Clin Transplant. 2016 Dec;14(6):656-659. doi: 10.6002/ect.2015.0213. Epub 2016 Apr 7.
Increased numbers of end-stage heart failure patients and improved technology have led to increased use of left ventricular assist devices as a viable alternative to heart transplants. Given the current economic climate, we compared costs of heart transplant versus device placement.
Medical records of patients who received heart transplants or left ventricular assist devices were cross-referenced with institutional financial data. The device cohort was limited to those receiving durable (not temporary) devices. Index admission, 1-year readmission, and overall 1-year charges were compared using standard statistical methods.
Of 184 identified patients with end-stage heart failure surgical therapy, 121 received left ventricular assist devices, 43 had heart transplants, and 20 received left ventricular assist devices as bridge to heart transplant; these latter patients were excluded from our analyses. At index admission, mean charges were $863 433 ± $398 427 for device patients and $725 877 ± $488 685 for transplant patients (P = .05). One-year mean readmission rates were similar (4.65/transplant patient and 4.53/device patient; P = .94), with corresponding 1-year survival rates of 87.8% and 78.0% (P = .04). Total readmission charges during year 1 were $169 732 ± $242 366 for device patients and $201 682 ± $297 565 for transplant patients (P = .08), with corresponding overall charges at 1 year of $1 029 732 ± $450 498 and $927 559 ± $562 404 (P = .49).
During the first year, heart transplant and left ventricular assist device placement have similar costs. Initial index admission costs seem to favor heart transplant, with device pump costs accounting for some of the difference. From a 1-year survival perspective, heart transplant may be more effective; however, with lack of suitable donors, left ventricular assist devices are valuable in the armamentarium of advanced heart failure surgical options.
终末期心力衰竭患者数量的增加以及技术的进步，使得左心室辅助装置作为心脏移植的一种可行替代方案的使用有所增加。鉴于当前的经济形势，我们比较了心脏移植与装置植入的成本。
将接受心脏移植或左心室辅助装置的患者的病历与机构财务数据进行交叉对照。装置队列仅限于接受耐用（非临时）装置的患者。使用标准统计方法比较首次入院、1年再入院情况以及总体1年费用。
在184例确诊的终末期心力衰竭手术治疗患者中，121例接受了左心室辅助装置，43例接受了心脏移植，20例接受左心室辅助装置作为心脏移植的过渡；后一组患者被排除在我们的分析之外。首次入院时，装置植入患者的平均费用为863433美元±398427美元，移植患者为725877美元±488685美元（P = 0.05）。1年平均再入院率相似（移植患者为4.65/例，装置植入患者为4.53/例；P = 0.94），相应的1年生存率分别为87.8%和78.0%（P = 0.04）。装置植入患者第1年的再入院总费用为169732美元±242366美元，移植患者为201682美元±297565美元（P = 0.08），相应的1年总费用分别为1029732美元±450498美元和927559美元±562404美元（P = 0.49）。
在第一年，心脏移植和左心室辅助装置植入的成本相似。首次入院的初始成本似乎有利于心脏移植，装置泵的成本是造成部分差异的原因。从1年生存率的角度来看，心脏移植可能更有效；然而，由于缺乏合适的供体，左心室辅助装置在晚期心力衰竭手术选择中具有重要价值。
