Background
Up to 50% of heart transplant candidates require bridging with left ventricular assist
devices (VAD). This study describes hospital activity and cost 1 year preceding and
1 year following VAD implant (pre-VAD) and for the year before transplant (pre-HTX).
The sample comprises an Australian cohort and is the first study to investigate costs
using both institutional and linked administrative data.
Methods
Institutional activity was established for 77 consecutive patients actively listed
for transplant between 2009 and 2012. Costs were sourced from the institution or Australian
refined diagnosis groups (arDRGs) and the National Efficient Price for admissions
to other public and private institutions. Data from 25/77 VAD recipients were analysed
and compared with data from 52/77 pre-transplant patients. Total and per day at risk
costs were assessed, as well as totals per resource.
Results
Fifty per cent (50%) of the hospital costs in the pre-VAD year occurred during admission
of VAD implant. Sixty-four per cent (64%) of costs in the pre-HTX and 38% in the pre-VAD
period occurred outside the implanting centre. Costs in the year prior to VAD, $97,565
(IQR $86,907–$153,916), were significantly higher than costs accrued in the year prior
to transplant, $40,250 ($13,493–$81,260), p < 0.0001. Once discharged, costs per day
at risk for post-VAD patients approximated those from the pre-admission period, p = 0.16
and in the more clinically stable pre-HTX cohort, p = 0.08.
Conclusion
Compared with the year prior, VAD implant stabilised hospital cost in patients discharged
home. A high proportion of the hospital costs in the pre-implant year occur outside
the implanting centre and should be considered in economic models assessing the impact
of VAD implant.
Keywords
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Article info
Publication history
Published online: August 28, 2019
Accepted:
August 12,
2019
Received in revised form:
July 21,
2019
Received:
July 19,
2018
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
