Elective or emergency heart transplantation: Cost comparison in a single center.

Abstract

Heart transplantation (HT) is the treatment of choice for selected cases of advanced heart failure. There is an increasing rate of emergency HT in our country. The aim of this study was to determine the cost of HT in our hospital according to emergent vs. elective transplantation status. The costs of all consecutive HTs performed in our center between January 2010 and May 2015 were analyzed. The cost of elective and emergent HT was compared. HT mean cost at our institution was €62203±47976. Elective HT mean cost was €47540±25140, whereas emergent HT cost was €102733±68050 (emergency status 1, as regional priority, was €66077±28067 and emergency status 0, as the highest national priority, was €136056±77080; P<0.001). Increased emergent HT cost was mainly related to a longer admission (32±24days vs. 69±53days; P=0.006; accounting for a cost of €14517±12475 vs. €37846±31702; P<0.001) and increased drug-related expenses (€6622±7465 vs. €15,171±15,758; P<0.02). Elective HT survival rate was 96%, compared to 68% for emergent HT; P=0.002. Elective HT showed a high survival rate with a relatively low and less variable cost, leading to a favorable economic balance in today's public health reimbursement system. In contrast, emergent HT showed a higher cost and a lower survival rate. New treatment strategies should be identified for heart failure patients at risk of requiring emergency HT.