COST, EFFECTIVENESS OF THERAPEUTIC STRATEGIES IN CANDIDATES FOR CARDIAC TRANSPLANTATION

A study of the real cost, the cost-effectiveness of treatment was perf ormed in 31 cases of cardiogenic shock referred for cardiac transplant ation, treated in a flexible therapeutic protocol associating implanta tion of an expensive mechanical circulatory support system (mechanical bridge) or treatment by drugs alone (pharmacological bridge) dependin g on the efficacy of IV enoximone. The average patient cost was 238 38 6 French Francs, ranging from 440 353 FF in patients receiving the mec hanical bridge to 199 296 FF in those receiving the pharmacological br idge. The cost-effectiveness ratio expressed either as cost per patien t surviving the different stages of the disease or as cost of obtainin g an additional day of survival at the same intervals was twice as fav ourable in the group receiving the pharmacological treatment. This stu dy suggests that IV enoximone and strict selection procedures for cand idates for the more expensive option should help bring together the in terest of the individual patient and of society as a whole.