Download 2004_ISHLT 2004 TLC-II Poster

LOWER COSTS ASSOCIATED WITH HOME DISCHARGE OF
BRIDGE-TO-TRANSPLANT PATIENTS USING THE TLC-II PORTABLE DRIVER
Research supported by Thoratec Corporation
BACKGROUND
RESULTS
Approximately 2,400 patients receive heart transplants each year. Of
those 2,400 patients, about 15 to 20 percent are first implanted with a
ventricular assist device (VAD) while awaiting a donor heart. In
November 2003, the TLC-II Portable Driver received FDA approval for
home use in support of bridge-to-transplant (BTT) patients implanted
with the Thoratec VAD System. Before the availability of the TLC-II
Portable Driver, patients were confined to an inpatient stay while
awaiting heart transplantation, averaging 108 days as previously
determined by DeRose1 et al.
From the literature review, it was determined that the costs during the
bridging period for continued inpatient stay were made up of general
floor, medication, laboratory tests, dressing supplies, and professional
fees. The daily costs for these components were $1,604, $3, $10, $5,
and $50 respectively. The estimated daily inpatient cost was
determined to be $1,672 per day.
Figure 1
Table 1
Continuous
Hospital Stay
Discharge
Home w/
TLC-II Purchase
Discharge
Home w/
TLC-II Rental
$1,604
$0
$0
Medication
$3
$3
$3
Laboratory
Tests
$10
$10
$10
$5
$5
$5
$50
$7
$7
$1,672
$25
$25
General Floor
Dressing
Supplies
Discharge to Home
Professional
Fees
Medical Costs
TLC-II
Purchase
TLC-II
Rental
Heart
Transplantation
OBJECTIVES
Our objective was to compare the medical costs incurred during home
discharge supported by a TLC-II Portable Driver versus continued
hospital inpatient stay, which is the current standard of care for a BTT
patient.
METHODS
In order to design a model to project medical costs during the bridging
period for a BTT, a literature review was undertaken. The following
were determined, based on data from the study by Morales2 et al, on
the associated cost of VADs, the Thoratec equipment price listing, and
industry experience:
Inpatient
Purchase
Rental
$180,000
$150,000
$90,000
Medical Costs Associated with TLC-II Driver
Bridge-to-Transplant Patient Path
Continued
Hospital
Inpatient
Stay
Projected Total Costs During Bridging Period
$120,000
Expenses
VAD
Implantation
Figure 2
For patients discharged home, the daily medical costs for medication,
laboratory tests, and dressing supplies are the same as in the hospital
inpatient setting. However, general floor costs are eliminated and
professional fees are reduced to $7 per day. The estimated daily cost
for home discharge was determined to be $25 per day.
$60,000
$30,000
$0
Day 1
Day 50
Day 100
The cost of continued hospital inpatient stay equaled the cost of home
discharge after 91.1 ($152,280) and 7.6 ($12,690) days of bridging
for the TLC-II Portable Driver purchase and rental scenario
respectively. The cost of a hospital inpatient stay for bridging days
greater than 91.1 in a purchase scenario and 7.6 in a rental scenario,
rose much faster than cost of home discharge.
Figure 3
Inpatient vs. Home Discharge Costs Assuming TLC-II
Purchase
$300,000
91.1 days
BTT w/o discharge
$250,000
Table 2
Summation of Costs Associated with TLC-II Driver
$200,000
$150,000
Expenses
Medical Cost
Cost of TLC-II
Continuous
Hospital Stay
Discharge
Home w/
TLC-II Purchase
Discharge
Home w/
TLC-II Rental
$1,672/day
$25/day
$25/day
$0
$150,000
$12,500/month
BTT w/ discharge (purchase)
$100,000
$50,000
$0
0
25
50
75
100
125
150
Day
Home discharge with the purchase ($150,000) or rental ($12,500) of
the TLC-II Portable Driver observed much higher initial cost than the
cost of a hospital inpatient stay. However, as the cost points were
projected over time, the cost of the hospital inpatient stay climbed
much more rapidly than the cost of home discharge.
Figure 4
Inpatient vs. Home Discharge Costs Assuming TLC-II
Rental
$100,000
7.6 days
BTT w/o discharge
$80,000
 Estimated inpatient cost per day
 Estimated home discharge cost per day
 Hospital acquisition cost for two TLC-II Portable Drivers as required
for FDA compliance
 Estimated TLC-II Portable Driver rental cost per month
The model was setup using a spreadsheet to calculate the costs
associated with a continued hospital inpatient stay, discharge home
with the purchase of two TLC-II Portable Drivers, and discharge home
with the rental of two TLC-II Portable Drivers over a range of 0 to 150
days.
"Being able to go home lifted my
spirits. I had more freedom and felt
that I could get back to recovering
at my own pace. I don't think I'd be
here today without that experience.“
- Joe Mazurek, TLC-II Patient
BTT w/ discharge (rental)
$20,000
$0
0
10
20
30
40
50
Day
Home discharge with the TLC-II Portable Driver may incur lower costs
than continued outpatient hospitalization if the bridging period is in a
purchasing scenario over three months or if the bridging period is in a
rental scenario over one week, both of which are within the typical
bridging time frame.
 Continued hospital inpatient stay:
[Cost = Inpatient Cost per Day x Days]
 Discharge home with purchase of two TLC-II Portable Drivers:
[Cost = (Home discharge cost per day x Days) +
TLC-II acquisition cost]
REFERENCES
 Discharge home with rental of two TLC-II Portable Drivers:
[Cost = (Home discharge cost per day x Days) +
TLC-II rental cost per month]
1. DeRose JJ, Umana JP, Argenziano M, et al. “Implantable left
ventricular assist device provide an excellent outpatient bridge to
transplant and recovery.” J Am Coll Cardiol 1997;30:1773-1777.
Scatter line graphs were plotted using the equations to compare:
 The cost of continued inpatient stay vs. home discharge with rental
of the TLC-II Portable Driver
$40,000
CONCLUSIONS
Equations for each cost scenario:
 The cost of continued inpatient stay vs. home discharge with
purchase of the TLC-II Portable Driver
$60,000
The compact 9.8 kg Thoratec TLC-II
Portable Driver provides
univentricular or biventricular
support for short- to long-term use.
2. Morales DL, Catanese KA, Williams MR, et al. “Six-year experience
of caring for forty-four patients with a left ventricular assist device at
home: safe, economical, necessary.” J Thorac Cardiovasc Surg
2000;119:251-9.