Impact of Insurance Coverage for Ventricular Assist Devices on Heart Transplant in Korea: A Single-Center Study

초록

Purpose: Insurance coverage for ventricular assist devices (VAD) was introduced in Korea in October 2018 and this reduced the patient’s out-of-pocket cost to 5% of the total medical expenses. This change is expected to increase the number of heart transplant (HT) candidates, enhance the use of donor hearts, and potentially lead to better outcomes for HT. This study aimed to evaluate the impact of insurance coverage for VADs on outcomes of HT. Methods: We compared patient characteristics, early and late mortality, as well as the rates of stroke, bleeding, infection, and intensive care unit (ICU) stays among retrospective cohorts of patients who underwent HTs at a single institution from 2015 to 2022. Patients were divided into two groups based on the operation date, depending on whether VAD insurance coverage was available. Results: Between 2015 and 2022, the annual volume of heart transplants remained steady, ranging from 21 to 34 cases. In the post-VAD insurance coverage era, the number of patients with VADs increased substantially, from 3.7% to 36.9% (P<0.01). The number of patients with myocardial infarction, chronic renal failure, and a history of cardiac surgery has also significantly increased. The prevalence of myocardial infarction increased from 22.4% to 41.8% (P<0.01), chronic renal failure from 15.9% to 34.4% (P<0.01), and a history of cardiac surgery from 21.5% to 59% (P<0.01). Early and late mortality rates were not significantly different when comparing the pre- and post-VAD insurance coverage era groups (2.8% vs. 3.3%; P=0.84 for early mortality; 16.8% vs. 15.4%; P=0.78 for late mortality). ICU stays are shorter in the post-VAD insurance coverage era groups, although the difference is statistically insignificant (19.5 days vs. 14.8 days; P=0.08). Conclusion: After insurance began covering VADs for five years, the annual volume of HTs has remained unchanged. The use of VADs as a bridge to HT has increased, enhancing the quality of life for HT candidates during the waiting period. The number of recipients with complex medical histories has increased, suggesting a broadening of candidacy for HTs. Postoperative outcomes have remained similar to those from the pre-insurance coverage era.