A cost comparison of heart transplantation versus alternative operations for cardiomyopathy

Background. Heart transplantation is an established therapy for cardiomyopa thy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repai r, and left ventricular reconstruction. Because it is unknown whether alter native operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elect ive heart transplantation. Methods. We compared clinical and financial data of 268 patients with eject ion fraction less than 30% who underwent elective heart transplantation (n = 52, UNOS status 2 only), coronary bypass (n = 176), mitral repair (n = 15 ), or left ventricular reconstruction (n = 25). Data were evaluated for bet ween-group differences, with p less than 0.05 as significant. Results. Preoperative ejection fraction, although similar for heart transpl antation (21.2% +/- 1.3%), coronary bypass (25.8% +/- 0.4%), mitral repair (22.9% +/- 1.5%), and left ventricular reconstruction (24.2% +/- 2.1%), was significantly different between the former two (P < 0.001). There was no d ifference in operative mortality: 5.8% (3 of 52), 3.4% (7 of 176), 6.7% (1 of 15), and 4.0% (1 of 25), respectively (p = 0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $ 75,992 +/- $5,380, $25,008 +/- $1,446, $32,375 +/- $2,379, and $26,584 +/- $4,076, respectively (p < 0.001). Organ procurement expenses alone comprise d 39.7% ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p = 0.86 ) Conclusions. Compared with heart transplantation, alternative operations yi eld a comparable early outcome and long-term survival, and are markedly les s expensive. The cost of transplantation, which is largely due to procureme nt expenses, is yet another reason to attempt alternative operations for ca rdiomyopathy whenever feasible. (C) 2001 by The Society of Thoracic Surgeon s.