Cost of Thoracotomy Approach: An Analysis of the LATERAL Trial. Journal Article

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Authors: Mokadam, NA; McGee, E; Wieselthaler, G; Pham, DT; Bailey, SH; Pretorius, GV; Boeve, T; Ismyrloglou, E; Strueber, M
Article Title: Cost of Thoracotomy Approach: An Analysis of the LATERAL Trial.
Abstract: BACKGROUND: Less invasive techniques for Left Ventricular Assist Device (LVAD) implantation have been increasingly prevalent over the last years and have been associated with improved clinical outcomes. The procedural economic impact of these techniques remains unknown. We sought to study and report economic outcomes associated with the thoracotomy implantation approach. METHODS: LATERAL is the first clinical trial evaluating the safety and efficacy of the thoracotomy approach for implantation of the HeartWare centrifugal-flow ventricular assist device system (HVAD). UB-04 forms were collected in parallel to the trial, allowing analysis of index hospitalization costs. All charges were converted to costs using hospital specific cost-to-charge ratios and were subsequently compared to Medicare cost data for the same period (2015-2016). Since thoracotomy implants were off-label for all LVADs during that period, the Medicare cohort was assumed to predominately consist of traditional sternotomy patients. RESULTS: Thoracotomy patients demonstrated decreased costs compared to sternotomy patients during the index hospitalization. Mean total index hospitalization costs for thoracotomy were $204,107 per patient, corresponding to 21.6% reduction (p0.0001) and $56,385 savings per procedure when compared to sternotomy. Across almost all cost categories, thoracotomy implants were found less costly. CONCLUSIONS: In LATERAL, the first clinical trial evaluating the safety and efficacy of the thoracotomy approach for HVAD, costs were found to be lower than the ones reported in Medicare patient claims occurring over the same period. Since Medicare data can be presumed to consist of predominately sternotomy procedures, Thoracotomy appears less expensive than traditional sternotomy.
Journal Title: The Annals of Thoracic Surgery
ISSN: 1552-6259; 0003-4975
Publisher: Unknown  
Date Published: 2020
LUC Authors
  1. Edwin McGee, Jr.
    21 McGee
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