Cost of 1-year left ventricular assist device destination therapy in chronic heart failure: a comparison with heart transplantation

Objective: To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation. Methods: Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (n=6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (n=19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (n=13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (6468 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation. Results: One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was (sic)85 531 +/- 19 823 for HTX, (sic)125 108 +/- 32 399 for bridging, and (sic)137 068 +/- 29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was (sic)138 076 +/- 19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is (sic)42 153 for HTX, (sic)53 637 for transplantation including the bridging cost, and (sic)47 487 for DT. Conclusion: Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.