Abstract

Recent evidence points to effectiveness of continuous inotropic infusion combined with automatic implantable cardioverter defibrillator (AICD) as an effective alternative to heart failure (HF) patient inhospital waiting cardiac transplantation. The purpose of this study was to cost HF outpatient inotropic therapy combined with AICD compared to in-hospital therapy. Outpatient inotropic therapy combined with AICD implantation for eligible HF patients awaiting cardiac transplantation was found to be a costsaving strategy. Background: Continuous infusion of inotropic agents (drugs that make the heart beat stronger) is a common bridge to cardiac transplantation for end-stage heart failure (HF) patients. Continuous inotropic infusion is often administered in hospital so patients can be monitored for life-threatening arrythmias. Recent evidence points to effectiveness of continuous inotropic infusion combined with automatic implantable cardioverter defibrillator (AICD) as an alternative to waiting for cardiac transplantation inhospital. The purpose of this study was to cost HF outpatient inotropic therapy combined with AICD compared to in-hospital therapy.

Method: Prospective cost data were collected on 21 consecutive HF patients receiving continuous outpatient inotropic therapy awaiting cardiac transplant over 3 years. Daily costs for outpatient therapy including drug delivery, infusion pump rental, per diem drug rates, visiting nurse costs, clinic billing, and equipment testing were calculated and compared to projected in-hospital costs.

Findings: Outpatient therapy yielded an estimated minimal cost savings of $71,300 to a maximum of $120,500 per patient. At $62,000 per procedure, AICD implantation was the largest single cost incurred by patients during outpatient. Despite this large fixed cost, the outpatient treatment protocol was always less expensive than in-hospital waiting. Using minimum hospital costs estimates, in-hospital treatment was more expensive than immediate discharge to home inotropic therapy post AICD implantation, provided the patient was treated for more than 40 days. In this study, only 5 out of 20 patients died or received cardiac transplant within 40 days. Since it is impossible to predict who will be on service less than 40 days, the analysis shows that overall, immediate discharge is the least costly strategy to adopt for all patients.

Conclusions: Outpatient inotropic therapy combined with AICD implantation for eligible HF patients is effective as a cost-saving strategy while awaiting cardiac transplantation.

Reference: Upadya SP, Sedrakyan A, Saldarriaga C, Nystrom K, Bozzo J, Lee FA, Katz SD. "Comparative costs of home positive inotropic infusion versus in-hospital care in patients awaiting cardiac transplantation." Journal of Cardiac Failure, 2004; 10(5), 384-9.