Medical and Financial Considerations Regarding Long-Term Mechanical Left Ventricular Support

Objectives: Technical improvements of the last assist devices along with the shortage of organs available for heart transplantation results in a steadily increase in number of patients on VAD. Aim of the current study was to report the impact in term of costs of those patients.

Methods: Demographic data of patients implanted with either 2nd or 3rd generation LVAD at our institution between July 1, 2009, and March 31, 2019, were retrospectively retrieved from our institutional database. Additionally, length of hospital stay, frequencies, reasons and duration of readmission for each outpatient as well as stationary revenues and case mix points were collected.

Results: A total of 163 patients (75.5% male) were included in the study. Mean age was 52 ± 14 years. At the implantation time, 56.8% of the patients were in INTERMACS level I or II. Average case mix value of the patients was 31.064 ± 24.821 at implantation and 3.664 ± 9.83 for a readmission. Mean duration of support was 750 ± 766 days. Mean postoperative duration of index stay was 70 ± 87 days and mean duration of a readmission was 18 ± 27 days. On average, patients spent 55.1% of the support time out of hospital. Longest treatment duration for non-device related complications was for malignancy. Mean survival in this patient population was 1.458 ± 169 days. For device related complication driveline or pump housing infections were associated with the longest hospital stays. Mean revenue for the index stay was 180.553,60 ¢ ± 104.487,19 ¢, for readmissions 48.662,58 ¢ ± 109.000,00 ¢ and for ambulatory care 49.715,58 ¢ ± 58.283,67 ¢. The highest total revenues were derived from readmission for recurrence of heart failure (2.047.675,48 ¢), followed by infections (2.011.997,34 ¢). The incremental cost-effectiveness ratio for patients implanted in INTERMACS level I was 148.277,12 ¢ per gained year of life and 131.823,73 ¢ per gained year of life in INTERMACS level II.

Conclusion: High-acquisition cost of the pumps along with frequent need for readmissions and long hospital stays of LVAD therapy are associated with a high financial burden for caregivers. Prevention of complications and the consequent need of rehospitalization must prompt prospective studies in order to improve quality of life and reduce costs.