# Economic Burden and Healthcare Trajectories of Patients Awaiting Heart Transplantation in a French Tertiary Center

## TL;DR

This study examines the economic costs and healthcare journeys of patients waiting for heart transplants in France, highlighting the impact of organ shortages.

## Contribution

The study introduces a novel approach to analyzing healthcare trajectories and costs for heart transplant candidates, emphasizing the economic burden of organ shortages.

## Key findings

- Patients awaiting heart transplants incurred an average cost of €21,324 with 2.71 hospitalizations.
- Type 4 patients who died before transplantation had the highest cost of €61,858 and three hospitalizations.
- Heart preservation devices like ex-vivo perfusion systems may help reduce the economic burden by expanding the donor pool.

## Abstract

Heart transplantation (HT) is the gold standard treatment of end-stage heart failure, but organ shortage remains a challenge. This retrospective cohort study assesses the economic burden and healthcare pathways of patients awaiting HT in a French tertiary center. Direct healthcare resources were collected and valued, and a state sequence analysis was performed. Ninety-two adult patients were included, with 67 (73%) undergoing HT within a median waiting time of 2 months. The mean cost per patient was €21,324.05 with an average of 2.71 hospitalizations. Four clusters were identified. Type 1 patients (n = 43) underwent HT within 1 month, with a mean cost of €5,820.12 per patient. Only 4 (25%) Type 2 patients (n = 16) underwent HT within 30 months, as they were not prioritized for HT, with a mean cost of €22,285.32 per patient. Type 3 patients (n = 20) underwent HT within 10 months, but incurred higher costs (€27,541.11) compared to Type 2 patients over a shorter period. Despite high transplant priority, Type 4 patients (n = 13) died before HT within 3 months, with a mean cost of €61,858.45 and 3 hospitalizations. This work highlights the economic burden of organ shortage. The use of novel heart preservation devices (such as ex-vivo perfusion systems) could help to expand the donor pool and alleviate this burden, but these aspects need to be further investigated.