Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study

Roslyn Prichard; Louise Kershaw; Stephen Goodall; Patricia Davidson; Phillip J Newton; Sopany Saing; Christopher Hayward

doi:10.1016/j.hlc.2019.08.008

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Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study

Journal article

Peer reviewed

Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study

Roslyn Prichard, Louise Kershaw, Stephen Goodall, Patricia Davidson, Phillip J Newton, Sopany Saing and Christopher Hayward

Heart, Lung & Circulation, Vol.29(9), pp.1338-1346

2020

DOI: https://doi.org/10.1016/j.hlc.2019.08.008

PMID: 32371031

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Abstract

Heart failure

Cost

Ventricular assist device

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.

Details

Title: Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study
Authors: Roslyn Prichard (Author) - University of Technology Sydney
Louise Kershaw (Author) - St Vincent’s Hospital, Sydney, NSW, Australia
Stephen Goodall (Author) - University of Technology Sydney
Patricia Davidson (Author) - Johns Hopkins University, Baltimore, MD, USA
Phillip J Newton (Author) - University of Technology Sydney
Sopany Saing (Author) - University of Technology Sydney
Christopher Hayward (Author) - St Vincent’s Hospital, Sydney, NSW, Australia
Publication details: Heart, Lung & Circulation, Vol.29(9), pp.1338-1346
Publisher: Elsevier Australia
DOI: 10.1016/j.hlc.2019.08.008
ISSN: 1444-2892
PMID: 32371031
Organisation Unit: University of the Sunshine Coast, Queensland; School of Nursing, Midwifery and Paramedicine - Legacy; School of Health - Nursing
Language: English
Record Identifier: 99512808202621
Output Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Web Of Science research areas: Cardiac & Cardiovascular Systems

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