Economic impact of mechanical cardiac assistance.

In contrast to heart transplantation, little effort has been made to estimate the economic implications of mechanical cardiac assistance from either a procedure- or a program-level perspective. With annual direct and indirect expenditures for the treatment of coronary artery disease and congestive heart failure now exceeding $65 billion in the United States, and the treatment options available for these diseases becoming increasingly diverse, it is important that we begin to better understand how expenditures for various treatment options compare. From a disease management perspective, it is also essential that policymakers have credible estimates of total program expenditures. At this time, program expenditures for heart transplantation in the United States are somewhere between $352 and $700 million. Given the availability of viable long-term mechanical cardiac assistance and the current need for cardiac replacement, total direct annual program expenditures could be as low as $5.4 billion or as high as $24 billion, depending on the expenses associated with device implantation and maintenance. By contrast, in 1996 the United States spent $9.8 billion on the treatment of end-stage renal disease. Clearly, the economics are such that viable mechanical cardiac assistance will likely engender considerable public policy debate.