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The Centers for Medicare and Medicaid Services have approved reimbursement for left ventricular assist devices, or LVADs – implantable heart pumps that have been shown to lengthen and improve the lives of end-stage heart failure patients. It is estimated that as many as 30,000 terminally ill people may benefit from the procedure.

Dr. Eric Rose, chairman of Surgery at P&S, led the landmark clinical trial that found the use of LVADs more than doubled the likelihood terminally ill heart failure patients would be alive at the end of one year. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial was published in the New England Journal of Medicine in November 2001. The device used in the REMATCH trial, the HeartMate VE, received FDA approval in November 2002.

"The decades of work spent on the development of the pump have been more than worth it," says Dr. Rose, who is also the Morris and Rose Milstein and Johnson & Johnson Professor of Surgery. "The pump will now be available to the sickest of the sick across the country."

Dr. Rose and colleagues recently published a cost analysis of LVADs for the REMATCH patients in the October Annals of Surgery. They found that the mean total cost to insert an LVAD in the study was $210,187, which includes a $60,000 charge for the device. The cost is similar to other life-saving organ replacement procedures such as liver transplant, which has an estimated cost of $203,434.

The analysis indicated that a blood infection or sepsis is the most important predictor of cost. When sepsis occurs, it more than doubles the cost of initial hospitalization, which adds about $140,000 to the cost of the stay. Improved LVAD designs available after the REMATCH trial should reduce the potential for infection, Dr. Rose says.

—Annie Bayne


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