Left Ventricular Assist Devices as Permanent Heart Failure Therapy: The Price of Progress

Mehmet C. Oz, Annetine C. Gelijns, Leslie Miller, Cuiling Wang, Patrice Nickens, Raymond Arons, Keith Aaronson, Wayne Richenbacher, Clifford Van Meter, Karl Nelson, Alan Weinberg, John Watson, Eric A. Rose, Alan J. Moskowitz, D. Glenn Pennington, William L. Holman, Nancy L. Ascher

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background Data: The REMATCH trial evaluated the efficacy and safety of long-term left ventricular assist device (LVAD) support in stage D chronic end-stage heart failure patients. Compared with optimal medical management, LVAD implantation significantly improved the survival and quality of life of these terminally ill patients. To date, however, there have been no analyses of the cost related to the LVAD survival benefit. This paper addresses the cost of hospital resource use, and its predictors, for long-term LVAD patients. Methods: Detailed cost data were available for 52 of 68 REMATCH patients randomized to LVAD therapy. We combined the clinical dataset with Medicare data, standard billing forms (UB-92), and line item bills provided directly by clinical centers. Charges were converted to costs by using the Ratio-of-Cost-to-Charges for each major resource category. Results: The mean cost for the initial implant-related hospitalization was $210,187 ± 193,295. When implantation hospitalization costs are compared between hospital survivors and nonsurvivors, the mean costs increase from $159,271 ± 106,423 to $315,015 ± 278,713. Sepsis, pump housing infection, and perioperative bleeding are the major drivers of implantation cost, established by regression modeling. In the patients who survived the procedure (n = 35), bypass time, perioperative bleeding, and late bleeding were the drivers of cost. The average annual readmission cost per patient for the overall cohort was $105,326. Conclusions: The cost of long-term LVAD implantation is commensurate with other life-saving organ transplantation procedures like liver transplantation. As an evolving technology, there are a number of opportunities for improvement that will likely reduce costs in the future.

Original languageEnglish
Pages (from-to)577-585
Number of pages9
JournalAnnals of Surgery
Issue number4
StatePublished - Oct 2003
Externally publishedYes


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