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Ann Thorac Surg 2001;71:S202-S203
© 2001 The Society of Thoracic Surgeons

Session 5: economics of devices

Discussion of economics of devices

William L. Holman, MD, Moderator, Friedhelm Beyersdorf, MD, Panelist, Jeanne Fitzgerald Dolak, MS, Panelist, Alan J. Moskowitz, MD, Panelist, Peer M. Portner, PhD, Panelist

Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.

DR WILLIAM L. HOLMAN (Birmingham, AL):

One thing that Dr Moskowitz mentioned during his talk was the concept of a quality-adjusted life year, which I think is a potentially powerful way of expressing to people in the business world and government the merit and value of mechanical circulatory support. A good example is in the Institute of Medicine report in which the investigators examined percutaneous transluminal coronary angioplasty (PTCA) and the cost of inappropriately used PTCA. In fact, the cost of an inappropriate angioplasty in a patient with single-vessel disease that is otherwise medically manageable, rivals the course of an appropriately used left ventricular assist device (LVAD). If you think about the economics, however, an inappropriately used LVAD is leveraged out of sight in terms of the cost per quality-adjusted life year, which makes the appropriate use and dispersal of the technology really crucial.

In the United States we have a "crazy quilt" of state-based certificate of need to determine which hospitals will use or be able to have the technology. In Europe, Dr Beyersdorf, how do they decide, or at least in your country, which hospitals are going to be able to implant LVADs?

DR FRIEDHELM BEYERSDORF (Freiburg, Germany):

Just a few months ago there was a joint effort from the Social Ministry and the insurance companies, and they actually decided on which medical centers would be allowed to use the technology. The driving force behind this decision was that there were, too many transplant centers, and some of them were doing only one or two . . . [Full Text of this Article]






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