[Cost and efficacy of therapeutic strategies in candidates for heart transplantation as salvage therapy].

A study of the real cost, the cost-effectiveness of treatment was performed in 31 cases of cardiogenic shock referred for cardiac transplantation, treated in a flexible therapeutic protocol associating implantation of an expensive mechanical circulatory support system (mechanical bridge) or treatment by drugs alone (pharmacological bridge) depending on the efficacy of IV enoximone. The average patient cost was 238,386 French Francs, ranging from 440,353 FF in patients receiving the mechanical bridge to 199,296 FF in those receiving the pharmacological bridge. The cost-effectiveness ratio expressed either as cost per patient surviving the different stages of the disease or as cost of obtaining an additional day of survival at the same intervals was twice as favourable in the group receiving the pharmacological treatment. This study suggests that IV enoximone and strict selection procedures for candidates for the more expensive option should help bring together the interest of the individual patient and of society as a whole.