1. Figure 2 Projected Total Costs During Bridging Period LOWER COSTS ASSOCIATED WITH HOME DISCHARGE OF BRIDGE-TO-TRANSPLANT PATIENTS USING THE TLC-II PORTABLE DRIVER BACKGROUND 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 DeRose 1 et al. VAD Implantation Continued Hospital Inpatient Stay Discharge to Home TLC-II Purchase TLC-II Rental Heart Transplantation 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 Morales 2 et al, on the associated cost of VADs, the Thoratec equipment price listing, and industry experience: 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. Equations for each cost scenario: 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] Discharge home with rental of two TLC-II Portable Drivers: [Cost = (Home discharge cost per day x Days) + TLC-II rental cost per month] Scatter line graphs were plotted using the equations to compare: The cost of continued inpatient stay vs. home discharge with purchase of the TLC-II Portable Driver The cost of continued inpatient stay vs. home discharge with rental of the TLC-II Portable Driver 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. Table 1 Medical Costs Associated with TLC-II Driver Expenses Continuous Hospital Stay Discharge Home w/ TLC-II Purchase Discharge Home w/ TLC-II Rental General Floor$1,604$0 Medication$3 Laboratory Tests $10 Dressing Supplies $5 Professional Fees $50$7 Medical Costs$1,672$25 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. Table 2 Summation of Costs Associated with TLC-II Driver Expenses Continuous Hospital Stay Discharge Home w/ TLC-II Purchase Discharge Home w/ TLC-II Rental Medical Cost$1,672/day$25/day Cost of TLC-II$0$150,000$12,500/month 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. RESULTS OBJECTIVES 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. 91.1 days BTT w/o discharge BTT w/ discharge (purchase) Figure 1 Bridge-to-Transplant Patient Path Figure 3 Inpatient vs. Home Discharge Costs Assuming TLC-II Purchase 7.6 days BTT w/o discharge BTT w/ discharge (rental) Figure 4 Inpatient vs. Home Discharge Costs Assuming TLC-II Rental CONCLUSIONS 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. REFERENCES 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. 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. Research supported by Thoratec Corporation "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 The compact 9.8 kg Thoratec TLC-II Portable Driver provides univentricular or biventricular support for short- to long-term use.