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  • Roslyn Prichard (a1), Louise Kershaw (a2), Patricia M. Davidson (a3), Phillip J. Newton (a4), Stephen Goodall (a5) and Christopher Hayward (a6)...



The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy.


Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009–12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission.


The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839–$271,743), versus $270,716 (IQR $211,740–$378,482) for the institutional micro-costing (p = .08).


Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional data can illuminate both the pathways to transplant referral and the hospital activity generated by patients experiencing the terminal phases of heart failure in the year before transplant, cf-VAD implant, or death.



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The authors acknowledge the assistance of St Vincent's Hospital finance department and in particular Melita Howes and Lai Mun Balnave for advice and support during the study. This investigator initiated study was supported by Heartware Inc. (C.H., Salary Support for research staff), the National Health and Medical Research Council (R.P. NHMRC post graduate scholarship APP1133337 and an Australian Government research training program scholarship). None of the other authors have a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose. The authors also thank the Centre for Health Record Linkage for the data linkage and the New South Wales Ministry of Health, for the use of linked data from the admitted patient and emergency department collections (APDC/EDDC).



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1.Kirklin, JK, Naftel, DC, Pagani, FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:14951504. doi:10.1016/j.healun.2015.10.003.
2.Nunes, AJ, MacArthur, RGG, Kim, D, et al. A systematic review of the cost-effectiveness of long-term mechanical circulatory support. Value Health. 2016;19:494504. doi:10.1016/j.jval.2014.12.020.
3.Kirklin, JK, Pagani, FD, Kormos, RL, et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:10801086. doi:10.1016/j.healun.2017.07.005.
4.Australian Government Department of Health. The prostheses list. (accessed December 5, 2016).
5.Birks, E. The comparative use of ventricular assist devices. Tex Heart Inst J 2010;37:13.
6.Sahle, BW, Owen, AJ, Mutowo, MP, et al. Prevalence of heart failure in Australia: A systematic review. BMC Cardiovasc Disord. 2016;16:32. doi:10.1186/s12872-016-0208-4.
7.Australia's Health 2014. Australian Institute of Health and Welfare 2014. 2014; (Cat. no. AUS 178):1578.
8.Xu, X, Grossetta Nardini, HK, Ruger, J. Micro-costing studies in the health and medical literature: Protocol for a systematic review. Syst Rev. 2014;3:47. doi:10.1136/bmj.38737.607558.80.
9.Frappier, J, Tremblay, G, Charny, M, Cloutier, LM. Costing bias in economic evaluations. J Med Econ. 2015;18:596599. doi:10.3111/13696998.2015.1033423.
10.Tan, SS, Bakker, J, Hoogendoorn, ME, et al. Direct cost analysis of intensive care unit stay in four European countries: Applying a standardized costing methodology. Value Health. 2012;15:8186. doi:10.1016/j.jval.2011.09.007.
11.Alvin, MD, Miller, JA, Lubelski, D, et al. Variations in cost calculations in spine surgery cost-effectiveness research. Neurosurg Focus. 2014;36:E1. doi:10.3171/2014.3.FOCUS1447.
12.Mercier, G, Naro, G. Costing hospital surgery services: The method matters. PLoS One. 2014;9:e97290. doi:10.1371/journal.pone.0097290.
13.Frick, KD. Microcosting quantity data collection methods. Med Care. 2009;47(Suppl):S76S81. doi:10.1097/MLR.0b013e31819bc064.
14.Kaplan, RS, Porter, ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89:4652.
15.Neumann, PJ. Costing and perspective in published cost-effectiveness analysis. Med Care. 2009;47(Suppl):S28S32. doi:10.1097/MLR.0b013e31819bc09d.
16.Tan, SS, Rutton, FF, Van Ineveld, BM, Redekop, WK, Roijen, LH-V. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2008;10:18. doi:10.1007/sl0198-008-0101-x.
17.National Hospital Cost Data Collection. Independent Hospital Pricing Authority; 2016. (accessed December 18, 2017).
18.Mishra, V, Fiane, AE, Winsnes, BA, et al. Cardiac replacement therapies: Outcomes and costs for heart transplantation versus circulatory assist. Scand Cardiovasc J. 2017;51:17. doi:10.1080/14017431.2016.1196826.
19.Marasco, SF, Summerhayes, R, Quayle, M, McGiffin, D, Luthe, M. Cost comparison of heart transplant vs. left ventricular assist device therapy at one year. Clin Transplant. 2016;30:598605. doi:10.1111/ctr.12725.
20.Patel, SR, Sileo, A, Bello, RB, et al. Heart transplantation versus continuous-flow left ventricular assist device: Comprehensive cost at 1 year. J Card Fail. 2015;21:160166. doi:10.1016/j.cardfail.2014.11.007.
21.Duckett, S. Improving accountability for use of blood products. Report to the Australian Red Cross Blood Service. June 2013:124. (accessed December 18, 2017).
22.Reeve, R, Haas, M. Estimating the Cost of Emergency Department Presentations in NSW. 2014:1–18. OPUS Library. (accessed December 18, 2017).
23.Briggs, A, Grey, A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 1998;3:233245.
24.Williams, ML, Trivedi, JR, McCants, KC, et al. Heart transplant vs left ventricular assist device in heart transplant-eligible patients. Ann Thorac Surg 2011;91:13301334. doi:10.1016/j.athoracsur.2011.01.062.
25.Damato, A. Improving patient outcomes: Leveraging data to drive innovation in health care – New South Wales’ Activity-Based Funding management portal. BMC Health Services Research. 2015;15(Suppl 2):A1. (accessed November 9, 2018).
26.Duckett, S. Blood money: Pathology cuts can reduce spending without compromising health. (accessed December 18, 2017).
27.Neil, A, Pfeffer, S, Burnett, L. Benchmarking in pathology: Development of a benchmarking complexity unit and associated key performance indicators. Pathology. 2013;45:6670. doi:10.1097/PAT.0b013e32835b77c4.
28.Medicare Benefits Schedule Book Category 6. May 2014:1–113.$File/201403-Cat6.pdf (accessed December 18, 2017).


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  • Roslyn Prichard (a1), Louise Kershaw (a2), Patricia M. Davidson (a3), Phillip J. Newton (a4), Stephen Goodall (a5) and Christopher Hayward (a6)...


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