Abstract 14694

Background: Mechanical circulatory support (MCS) is commonly used as a bridge to heart transplant (HT) in pediatric patients. Given recent changes in pediatric donor allocation policies, the use of MCS will likely increase. There are limited published data on the costs associated with pediatric HT. The aim of this study was to utilize a novel linkage of clinical registry and administrative data to determine the impact of MCS strategy (VAD vs ECMO) on hospitalization costs in children undergoing HT.

Methods: Using a unique linked dataset we identified all pediatric HT recipients in the PHIS and SRTR databases (2002-2016). Hospital costs (total and post-HT) were estimated based on hospital charges and cost-to-charge ratios, inflated to 2016 dollars. Risk adjusted patient costs were calculated using generalized linear mixed effects models with a random hospital intercept. Unadjusted and adjusted costs were analyzed based on MCS strategy (None, VAD, ECMO, or ECMO followed by VAD) and compared using the Kruskal-Wallis test.

Results: A total of 2902 pediatric HT recipients with available cost data were analyzed. Median risk-adjusted cost for the total HT hospitalization among all recipients was $512,946 (IQR $375,575-$760,227) with post-HT costs of $332,293 (IQR $263,260-$449,060). Total hospitalization costs were greater for those supported by any form of MCS, relative to those who did not require MCS (table). Post HT costs for those supported by ECMO ($540,572) or ECMO to VAD ($493,578) were also greater than those who did not require MCS ($324,887; p<0.001 for both). However post-HT costs for those supported by VAD in the absence of ECMO were similar to those who did not require any form of MCS ($328,512 vs. 324,887, p=0.64).

Conclusion: MCS as a bridge to HT in children is associated with greater costs during the entire HT hospitalization. However, VAD support minimizes post-HT costs compared to support with ECMO and thus represent a more cost-effective support strategy.