The cost of long-term LVAD implantation

Background. With increasing use of left ventricular assist devices (LVAD) w orldwide, the economics of LVAD implantation have become an important focus of concern. Although these devices have high unit costs, they are the only hope for survival for a large group of terminally ill patients and are lik ely to have an expansion in indications for use. Methods. We calculated the costs associated with longterm LVAD implantation . We used the ratio of cost-to-charges method to calculate hospital costs p er resource category, market prices for drugs and device, and payments for physician services. Results. Based on our experience with "bridge-to-transplantation" patients, we estimated average first-year costs to be $222,460 including professiona l fees and $192,154 excluding professional fees. The latter figure is compa rable to average first-year costs for cardiac transplantation, which is $17 6,605 without professional fees at our institution. Conclusions. The costs of LVAD therapy will change after the first year of implantation, and device reliability and longevity will be important factor s in determining these costs. Should the costs of LVAD therapy continue to track those of cardiac transplantation, devices will be cost-effective only if they offer similar efficacy to cardiac transplantation. (C) 2001 by The Society of Thoracic Surgeons.