A cost comparison of heart transplantation versus alternative operations for cardiomyopathy

Jeffrey T. Cope, Aditya K. Kaza, Clifton C. Reade, Kimberly S. Shockey, John A. Kern, Curtis G. Tribble, Irving L. Kron

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. Heart transplantation is an established therapy for cardiomyopathy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repair, and left ventricular reconstruction. Because it is unknown whether alternative operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elective heart transplantation. Methods. We compared clinical and financial data of 268 patients with ejection fraction less than 30% who underwent elective heart transplantation (n=52, UNOS status 2 only), coronary bypass (n=176), mitral repair (n=15), or left ventricular reconstruction (n=25). Data were evaluated for between-group differences, with p less than 0.05 as significant. Results. Preoperative ejection fraction, although similar for heart transplantation (21.2%±1.3%), coronary bypass (25.8%±0.4%), mitral repair (22.9%±1.5%), and left ventricular reconstruction (24.2%±2.1%), was significantly different between the former two (p<0.001). There was no difference in operative mortality: 5.8% (3 of 52), 3.4%(7 of 176), 6.7% (1 of 15), and 4.0% (1 of 25), respectively (p=0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $75,992±$5,380, $25,008±$1,446, $32,375±$2,379, and $26,584±$4,076, respectively (p<0.001). Organ procurement expenses alone comprised 39.7% ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p=0.86). Conclusions. Compared with heart transplantation, alternative operations yield a comparable early outcome and long-term survival, and are markedly less expensive. The cost of transplantation, which is largely due to procurement expenses, is yet another reason to attempt alternative operations for cardiomyopathy whenever feasible.

Original languageEnglish (US)
Pages (from-to)1298-1305
Number of pages8
JournalAnnals of Thoracic Surgery
Volume72
Issue number4
DOIs
StatePublished - Oct 16 2001
Externally publishedYes

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Hospital Costs
Mitral Valve Insufficiency
Left Ventricular Dysfunction
Heart Transplantation
Cardiomyopathies
Mitral Valve
Coronary Artery Bypass
Cost-Benefit Analysis
Length of Stay
Costs and Cost Analysis
Tissue and Organ Procurement
Survival
Kaplan-Meier Estimate
Survival Analysis
Heart Diseases
Transplantation
Transplants
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

A cost comparison of heart transplantation versus alternative operations for cardiomyopathy. / Cope, Jeffrey T.; Kaza, Aditya K.; Reade, Clifton C.; Shockey, Kimberly S.; Kern, John A.; Tribble, Curtis G.; Kron, Irving L.

In: Annals of Thoracic Surgery, Vol. 72, No. 4, 16.10.2001, p. 1298-1305.

Research output: Contribution to journalArticle

Cope, Jeffrey T. ; Kaza, Aditya K. ; Reade, Clifton C. ; Shockey, Kimberly S. ; Kern, John A. ; Tribble, Curtis G. ; Kron, Irving L. / A cost comparison of heart transplantation versus alternative operations for cardiomyopathy. In: Annals of Thoracic Surgery. 2001 ; Vol. 72, No. 4. pp. 1298-1305.
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abstract = "Background. Heart transplantation is an established therapy for cardiomyopathy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repair, and left ventricular reconstruction. Because it is unknown whether alternative operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elective heart transplantation. Methods. We compared clinical and financial data of 268 patients with ejection fraction less than 30{\%} who underwent elective heart transplantation (n=52, UNOS status 2 only), coronary bypass (n=176), mitral repair (n=15), or left ventricular reconstruction (n=25). Data were evaluated for between-group differences, with p less than 0.05 as significant. Results. Preoperative ejection fraction, although similar for heart transplantation (21.2{\%}±1.3{\%}), coronary bypass (25.8{\%}±0.4{\%}), mitral repair (22.9{\%}±1.5{\%}), and left ventricular reconstruction (24.2{\%}±2.1{\%}), was significantly different between the former two (p<0.001). There was no difference in operative mortality: 5.8{\%} (3 of 52), 3.4{\%}(7 of 176), 6.7{\%} (1 of 15), and 4.0{\%} (1 of 25), respectively (p=0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $75,992±$5,380, $25,008±$1,446, $32,375±$2,379, and $26,584±$4,076, respectively (p<0.001). Organ procurement expenses alone comprised 39.7{\%} ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p=0.86). Conclusions. Compared with heart transplantation, alternative operations yield a comparable early outcome and long-term survival, and are markedly less expensive. The cost of transplantation, which is largely due to procurement expenses, is yet another reason to attempt alternative operations for cardiomyopathy whenever feasible.",
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T1 - A cost comparison of heart transplantation versus alternative operations for cardiomyopathy

AU - Cope, Jeffrey T.

AU - Kaza, Aditya K.

AU - Reade, Clifton C.

AU - Shockey, Kimberly S.

AU - Kern, John A.

AU - Tribble, Curtis G.

AU - Kron, Irving L.

PY - 2001/10/16

Y1 - 2001/10/16

N2 - Background. Heart transplantation is an established therapy for cardiomyopathy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repair, and left ventricular reconstruction. Because it is unknown whether alternative operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elective heart transplantation. Methods. We compared clinical and financial data of 268 patients with ejection fraction less than 30% who underwent elective heart transplantation (n=52, UNOS status 2 only), coronary bypass (n=176), mitral repair (n=15), or left ventricular reconstruction (n=25). Data were evaluated for between-group differences, with p less than 0.05 as significant. Results. Preoperative ejection fraction, although similar for heart transplantation (21.2%±1.3%), coronary bypass (25.8%±0.4%), mitral repair (22.9%±1.5%), and left ventricular reconstruction (24.2%±2.1%), was significantly different between the former two (p<0.001). There was no difference in operative mortality: 5.8% (3 of 52), 3.4%(7 of 176), 6.7% (1 of 15), and 4.0% (1 of 25), respectively (p=0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $75,992±$5,380, $25,008±$1,446, $32,375±$2,379, and $26,584±$4,076, respectively (p<0.001). Organ procurement expenses alone comprised 39.7% ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p=0.86). Conclusions. Compared with heart transplantation, alternative operations yield a comparable early outcome and long-term survival, and are markedly less expensive. The cost of transplantation, which is largely due to procurement expenses, is yet another reason to attempt alternative operations for cardiomyopathy whenever feasible.

AB - Background. Heart transplantation is an established therapy for cardiomyopathy but is limited by organ shortage and expense. As a result, alternative operations have been proposed including coronary bypass, mitral valve repair, and left ventricular reconstruction. Because it is unknown whether alternative operations are less expensive than replacing the diseased heart, we compared in-hospital costs and early outcome of these operations with elective heart transplantation. Methods. We compared clinical and financial data of 268 patients with ejection fraction less than 30% who underwent elective heart transplantation (n=52, UNOS status 2 only), coronary bypass (n=176), mitral repair (n=15), or left ventricular reconstruction (n=25). Data were evaluated for between-group differences, with p less than 0.05 as significant. Results. Preoperative ejection fraction, although similar for heart transplantation (21.2%±1.3%), coronary bypass (25.8%±0.4%), mitral repair (22.9%±1.5%), and left ventricular reconstruction (24.2%±2.1%), was significantly different between the former two (p<0.001). There was no difference in operative mortality: 5.8% (3 of 52), 3.4%(7 of 176), 6.7% (1 of 15), and 4.0% (1 of 25), respectively (p=0.8). However, total hospital cost of heart transplantation was significantly greater than all others: $75,992±$5,380, $25,008±$1,446, $32,375±$2,379, and $26,584±$4,076, respectively (p<0.001). Organ procurement expenses alone comprised 39.7% ($30,169) of total transplant cost. Kaplan-Meier survival analysis failed to show any survival difference between the various groups (p=0.86). Conclusions. Compared with heart transplantation, alternative operations yield a comparable early outcome and long-term survival, and are markedly less expensive. The cost of transplantation, which is largely due to procurement expenses, is yet another reason to attempt alternative operations for cardiomyopathy whenever feasible.

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