Abstract
Background: Since Left Ventricular Assist Devices were approved in the US for destination therapy, there has been a rapid increase in their use. Information on the cost of advanced heart failure management (AHF), transplant (HTX) and VAD programs is variable across health systems, as most cost data is derived from casemix costing, charges or claims against insurers. This weakens comparative studies as eligible AHF patients are cost outliers in the broader heart failure population. We outline a cost effectiveness study of VAD therapy vs AHF as part of an HTX program, using Time Driven Activity Based Costing of identified models of care in an Australian setting. Methods: All patients activated to the HTX waitlist between 07/2009 and 06/2012 (n=101) were screened and 86 included (62 AHF, 24 VAD). Models of care were defined through 13/86 file reviews, clinician interviews and analysis of activity. Detailed costing was undertaken for 5 VAD and 8 AHF patients for 12 months pre and post HTX listing or VAD implant and included medical, allied health, nursing activities, inpatient care and clinic visits (ClinV), consumables, drugs, pathology, medical imaging, and prosthetics. Results: Mortality at 1 yr was 12% (3/24) for VADs post implant and 11% (7/62) for AHF post HTX activation. 148 service activities were identified in 13 file reviews ranging from basic documentation to ECMO insertion. The two groups were matched for age, AHF etiology and gender. In house database interrogation yielded a median pathology cost per patient of $4811 in 17/24 Pre VAD, and $12,294 in 20/24 Post VAD patients,. Median allied Health cost for 19/24 Pre VAD patients was $545 and in 23/24 Post VAD was $2938 ($AUD) Hospitalisations and costs borne beyond the transplant center made comparison between VAD therapy and AHF incomplete. Conclusion: The BTT VADs were sicker, with more days hospitalized pre and post VAD. From an institutional and health system perspective, correct identification of, and reimbursement for activities related to best practice models of care is crucial. Cost effectiveness, capturing costs borne at other hospitals as well as federal, drug and GP reimbursements should be addressed in this cohort.
Published Version
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