Temporal Changes in Hospital Costs for Left Ventricular Assist Device Implantation

BACKGROUND: A recent prospective, randomized controlled trial demonstrated that a continuous-flow (CF) left ventricular assist device (LVAD) resulted in improved survival at 12 and 24 months compared to a pulsatile-flow (PF) device. The current study examines the hospitalization costs associated with treatment of New York Heart Failure Class IV patients when implanted with a CF LVAD and compares them to previously reported costs of a PF LVAD in the same population. METHODS: Hospital billing data were analyzed for CF LVAD patients in the HeartMate II Destination Therapy trial to determine costs associated with the implantation admission. Hospital charges were converted to costs using hospital specific cost-to-charge ratios. Hospital costs were evaluated based on patient outcomes and compared to previously reported results from patients who received a pulsatile flow LVAD in Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Multivariate models were created to determine the primary determinates of cost. RESULTS: Hospital bills were available for 83 CF and 52 PF LVAD patients. Hospital length of stay and in-hospital mortality were lower in the CF cohort. Inflation-adjusted hospital costs were significantly lower for CF patients compared to PF patients (mean: $193,812 vs. $384,260, p < 0.001). Clinical factors that strongly influenced hospitalization costs included bleeding, respiratory failure, and infection. CONCLUSIONS: There has been a 50% reduction in the hospitalization cost associated with LVAD implantation since 2001. Improvements in operative technique and postoperative management appear to play critical roles in the observed cost reduction.