OBJECTIVES: Recent advances in left ventricular assist device (LVAD) technology have made this therapy a lifesaving bridge to orthotopic heart transplant (OHT) in patients with heart failure who fail maximal medical therapy, including positive inotropic support. This study examined the costs of LVAD versus traditional intravenous positive inotropic support strategies in patients awaiting OHT. METHODS: To determine the economic impact of using either LVAD or positive inotropic for patients surviving awaiting OHT, we retrospectively examined the itemized inpatient billing records of all patients who underwent OHT in 1993 (N=18) and 1996 (N=32) at our center. PreOHT costs (in 1997 US$) were calculated for each billed item using institutional cost:charge ratios. Items were categorized as pharmacy, procedure, laboratory, bed, blood product, respiratory care, and supply. Professional fees were excluded from the analysis. Perdiem costs were calculated to control for interpatient differences in length of stay. RESULTS: LVAD support was utilized in 10 patients, and the remaining 40 patients received only positive inotropic therapy prior to OHT. The groups were demographically and clinically similar. PreOHT length of stay was 113?63 days vs 71?46 days (LVAD vs positive inotrope groups; p=0.02). Total preOHT perdiem costs were $3651?1510 for LVAD patients and $2625?602 for positive inotrope patients (p<0.01). Although perdiem pharmacy and bed costs were similar, costs in the LVAD patients for procedures ($794?667 vs $237?289), laboratories ($436?280 vs $260?138), blood products ($122?148 vs $12?16), respiratory care ($222?263 vs $61?123), and supplies ($223?131 vs $141?62) were significantly higher than in positive inotrope-supported patients (p<0.01 for all). CONCLUSIONS: In this study, length of stay and perdiem costs were higher in patients requiring LVAD implantation as a bridge to transplant. These increased costs may be justified given the extremely high mortality of these patients in the absence of LVAD support.