Abstract 3376: The Outcomes and Costs of Intracorporeal and Extracorporeal Left Ventricular Assist Devices: An Analysis of the Centers for Medicare and Medicaid Services Database
PURPOSE: There is an increasing body of literature examining the costs of mechanical circulatory support. However, few studies differentiate between device types. The purpose of this study was to compare outcomes and costs of Medicare beneficiaries receiving left ventricular assist devices (LVAD) intracorporeal (INTRA) versus extracorporeal (EXTRA) support.
METHODS: De-identified inpatient claims data were obtained from the Centers for Medicare and Medicaid services for the period of 1/1/2001 to 12/31/2004. Medicare beneficiaries included in the analysis received a LVAD alone during this time period (N=720). Patients with the ICD9 code 37.66 were grouped into the INTRA group and the EXTRA group included patients with an ICD9 37.62 and/or 37.65. Outcome measures included mean inpatient costs for index hospitalization, survival, support on device, and length of stay. Sub-analysis of Medicare payments by discharge status was completed to assess differences in resource utilization.
RESULTS: Mean total costs of the index hospitalization for patients on INTRA devices ($170,277.60 +/− $120,649.60) was significantly higher (p<0.001) than patients on EXTRA devices ($103,889.40 +/− $106,483.30). Mean length of stay of the index hospitalization for patients on INTRA devices (63.23 days +/− 68.17) was significantly longer (p<0.001) than patients on EXTRA devices 34.21 days +/− 59.40). There was a slight trend (p=0.099) toward better survival during the index hospitalization in the INTRA group (n=244, 76.7%) compared with the EXTRA group (n=288, 71.3%)
CONCLUSIONS: During the study period resource utilization during the index hospitalization related to LVAD implantation remained high. Though given the significant morbidity among patients requiring VAD support, survival rates during index hospitalization and to transplant at 1 year were better in the INTRA group. Additional analysis is needed to determine the costs and benefits of use of LVADs.