Costs Associated With Ventricular Assist Device Use in Children
- 30 November 2008
- journal article
- Published by Elsevier BV in The Annals of Thoracic Surgery
- Vol. 86 (5), 1592-1597
- https://doi.org/10.1016/j.athoracsur.2008.07.022
Abstract
Background. Ventricular assist devices (VADs) allow children with severe heart failure to be bridged to success- ful heart transplantation. Ventricular assist devices are being used with increasing frequency in the pediatric population, and newer devices allow even young infants to be supported. Ventricular assist device implantation and maintenance, how- ever, is quite expensive, and the cost-effectiveness of VAD use in adults has been questioned. To date, an economic analysis of VAD support in children has not been undertaken. Methods. We used Pediatric Health Information System, an administrative database of the Child Health Corporation of America (a consortium of Children's Hospitals in North America), to determine the outcomes and costs related to VAD use in children. Data on patients younger than 18 years of age from 2002 to 2007 were reviewed. Hospital charges were converted to costs based on cost-to-charge ratios. Projected survival for subjects who were success- fully bridged to heart transplant was derived from pub- lished data. The model assumed that if a VAD strategy were not used, the majority of subjects would have re- quired extracorporeal membrane oxygenation support as a bridge to transplantation. Cost-utility was expressed as cost per quality-adjusted life years saved. All future costs and benefits were discounted at 3%. Results. There were 145 children who underwent VAD implantation at 19 centers in North America. The median age at admission was 8.5 years; the range was newborn to 17.7 years. The median duration of VAD support was 43 days (range, 1 to 465 days). Ninety-four patients (65%) survived to heart transplantation. Thirty-nine (27%) pa- tients died during hospitalization. There were 12 patients (8%) who had VAD explantation and survival to hospital discharge. The mean hospital cost was $624,798. When compared with a strategy of extracorporeal membrane oxygenation support, the calculated cost-utility for VAD as a bridge to transplantation was $119,937 per quality- adjusted life year saved. When key assumptions were changed, the cost-utility varied from $88,304 to $282,320 per quality-adjusted life year saved. Conclusions. Ventricular assist devices allow an effective bridge to heart transplantation in children. Under base-case assumptions, the cost-effectiveness ratios exceed the thresh- old of $100,000 per quality-adjusted life year saved. The cost-utility of this strategy, however, is comparable to a number of other life-saving technologies.Keywords
This publication has 23 references indexed in Scilit:
- Registry of the International Society for Heart and Lung Transplantation: Tenth Official Pediatric Heart Transplantation Report—2007The Journal of Heart and Lung Transplantation, 2007
- Mechanical Cardiac Support in the Young With the Berlin Heart EXCOR Pulsatile Ventricular Assist Device: 15 Years’ ExperienceSeminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 2006
- Evaluation of the ventricular assist device programme in the UKHealth Technology Assessment, 2006
- Subcutaneous Low Molecular Weight Heparin for Management of Anticoagulation in Infants on Excor Ventricular Assist DeviceAsaio Journal, 2006
- Ventricular Assist Device Support in Children and Adolescents as a Bridge to Heart TransplantationThe Annals of Thoracic Surgery, 2006
- Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist DevicesCirculation, 2006
- Extracorporeal membrane oxygenation in pediatric cardiac transplantationJournal of Pediatric Surgery, 2005
- Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in childrenThe Journal of Thoracic and Cardiovascular Surgery, 2005
- Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantationThe Journal of Heart and Lung Transplantation, 2003
- Use of assist devices and ECMO to bridge pediatric patients with cardiomyopathy to transplantationThe Journal of Heart and Lung Transplantation, 2002