November 11, 1994
Media Contact:Michael Purdy
Phone: (410) 955-6680
E-mail: MPurdy@welchlink.welch.jhu.edu

Thousands of Americans are candidates for heart transplants, but many will not receive them until they become desperately ill, because donor organs are in short supply. Now a recent study by Johns Hopkins cardiologists shows that such delayed transplants are not only riskier for recipients, but less cost-effective than those performed in healthier patients.

"We're giving hearts first to the people who need them most, and that's correct," says Kenneth Baughman, M.D., director of cardiology at Hopkins and an author of the study. "But because the sickest patients await transplants in intensive care units, and require life support, their pre-operative care is expensive. They also tend to require longer hospitalization after the transplant."

"An increasing number of heart transplants are going to the sickest of the sick," says David Thiemann, M.D., a cardiology fellow at Johns Hopkins and the lead author of the study. Thiemann and six coauthors found that transplants are a third more expensive for so-called Status 1 patients, who await transplants in intensive care units than for other patients.

The researchers conducted a detailed cost-analysis of 145 heart transplant patients over a 10-year period, and found that overall heart transplants are somewhat more expensive than other widely used medical procedures such as kidney dialysis. They also found that the overall cost-effectiveness of heart transplants is reduced by costs incurred by Status 1 patients.

Projecting their results to estimate costs over 15 years of life, they found that heart transplants cost an average of $40,700 per year of life saved. "Transplantation," says Thiemann, "is somewhat more expensive than many existing treatments, but not wildly more expensive. It's in the ballpark." A heart transplant, he says, costs approximately $10,000 more per year of life than kidney dialysis.

If more Americans arranged to donate their organs, says Baughman, more transplants could be performed before recipients became acutely ill. In Europe, he points out, where consent for organ donation is implied, more organs are available for transplants.

This is an important point, since expensive medical procedures are coming under increasing scrutiny by policy-makers, says Baughman. "People need to recognize that the cost of a heart transplant depends to a large extent on the condition of the recipient," he says.

Thiemann and his coauthors calculated the average annual costs incurred from the year of the transplant onward, based on expenses and survival rates in consecutive adult transplant recipients at Hopkins between 1983 and 1993. He is scheduled to present their study on November 14, 1994 at the American Heart Association's annual meeting in Dallas.

According to the United Network for Organ Sharing, more than 2,800 people are currently on the national waiting list for heart transplants. In 1993, nearly 2,400 patients received heart transplants. The number of hearts available for transplantation in the United States has increased only slightly since 1990.

"If people want to lower the cost of heart transplants," says Baughman, "they should arrange to donate their organs, so more transplants can be done earlier and more cost-effectively."

-- JHMI --
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