RESUMO
OBJECTIVE: To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation. METHODS: Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (nâ=â6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (nâ=â19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (nâ=â13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (64±8 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation. RESULTS: One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was 85 531±19 823 for HTX, 125 108±32 399 for bridging, and 137 068±29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was 138 076±19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is 42 153 for HTX, 53 637 for transplantation including the bridging cost, and 47 487 for DT. CONCLUSION: Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.
