247RESOURCES AND COST EVALUATION OF A DESTINATION THERAPY VENTRICULAR ASSIST DEVICE PROGRAMME

• Published in: Interactive cardiovascular and thoracic surgery 2013-10, Vol.17 (suppl_2), p.S129-S129
• Main Authors: Barbone, A., Pini, D., Basciu, A., Cappai, A., Alemanno, F., Vanni, E., Ornaghi, D., Tarelli, G., Lettino, M., Vitali, E.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.247

Objectives: Destination therapy (DT) with mechanical circulatory support is an accepted therapy for patients with end-stage congestive heart failure, who are not candidates for heart transplantation. We have evaluated the resource allocations which this therapy might require. Methods: At our institution we have had experience with bridge to transplant ventricular assist devices (VADs) since the year 2000; since September 2010 we have implanted 12 patients with a destination therapy indication. Patients were implanted with both full and partial support devices, through full sternotomy or thoracotomy. Outcomes were evaluated both in terms of hospital bed occupation and resource allocation. Results: The mean age of the patients and INTERMACS class were 70.1 ± 4.1 years and 2.9 ± 0.9 respectively. The total follow up achieved was 9.2 years (range 14-841 days). Two patients died within 30 days of implant, one due to GE and one to late surgical bleeding. During follow-up, data were collected on an overall 201 office visits and 65 hospital admissions for a total of 1056 days (393 Intensive Care Unit [ICU] admission days), estimating overhead expenses of 479 000€ (338 000€ ICU expenses). To this needs to be added 32 000€ for operating room costs, 42 000€ for blood bank (transfusions), 69€ for extra/follow-up personnel, 133 000€ for diagnostics and a further 130 000€ of un-itemized hospital costs. This ends in a daily cost for the therapy of 262€ per patient/day before device cost. Conclusions: In this limited experience, DT patients seem to absorb more resources than expected, mostly required to manage later complications (ICU accounts for more than 50% of direct costs). Device costs are on top of this burden. Further improvement in devices is required to reduce the complications' rate and thus help widespread diffusion of this therapy.