Abstract 5856: Long-term Outcomes and Costs of Ventricular Assist Devices among United States Medicare Beneficiaries
BACKGROUND: Little is known about long-term outcomes and costs associated with VAD therapy among Medicare beneficiaries.
METHODS: Using the 100% inpatient and denominator files from 2000–2006, we identified Medicare fee-for-service beneficiaries as VAD only or VAD post-cardiotomy (at time of or within 30 days of cardiac surgery) and followed outcomes. Cumulative incidence of VAD reimplantation, explantation, cardiac transplantation, readmission and death were estimated accounting for censoring and competing risks. Cox proportional hazards model was used to determine factors associated with time-to-death. Inpatient costs–total and per survived day outside of the hospital were calculated from Medicare payments.
RESULTS: From 2000 through 2005, 2701 patients received a VAD from 549 hospitals; 1379 (51%) VADs post-cardiotomy and 1322 (49%) VAD only. Overall index hospital survival rate was 67% for VAD only and 39% for VAD post-cardiotomy. By one year these survival rates declined to 52% and 31% respectively (Figure⇓). Mean inpatient cost to Medicare in the first year was $178,626 (± $143,120) for VAD only and $112,013 (± $95,473) for VAD post-cardiotomy. For all VAD recipients, Medicare inpatient expenditures per day survived and out of the hospital were $1,021 for year 1 and $466 over 3 years.
CONCLUSIONS: VAD therapy is being used more commonly for end stage heart failure among Medicare beneficiaries; however, mortality and costs remains high. Advances in technology, and improved patient selection are needed before the use of VADs can expand more widely.