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Keeping former Vice President Dick Cheney's heart beating probably will cost at least a million dollars, heart failure experts told MedPage Today.
"Considering all the procedures and devices and operations, Vice President Cheney has gone through, I think it would be fair to call him a 'million dollar man'," said Mary Norine Walsh, MD, Medical Director of the Cardiac Transplant Patient Program at St. Vincent Heart Center in Indianapolis and spokesperson for the American College of Cardiology.
In more than three decades since he first suffered a heart attack until his heart transplant Saturday, Cheney has run up formidable costs as he progressed from heart disease to heart failure, while putting a very public face on state-of-the-art cardiac treatment.
"Dick Cheney has been very open about his heart treatment," said Mariell Jessup, MD, professor of medicine at the University of Pennsylvania, Philadelphia, and a spokesperson for the American Heart Association, "and for that reason he has helped inform the nation about heart health issues. He has been very good for us in that aspect."
Walsh told MedPage Today that Cheney's heart transplant – after 20 months waiting for an appropriate organ – is the most expensive item on his personal health bill. She said it was likely that the procedure itself could cost up to $250,000, but the immediate follow-up care is going to be just as expensive as the initial procedure.
"He is going to need repeat cardiac biopsies to monitor possible rejection of the heart," Walsh said. "During the first year he will have to undergo cardiac catheterization procedures perhaps 10 to 12 times," she said. The hospital charges for these procedures – including cath lab time, physicians' services, pathology, and other costs -- could add another $200,000 to his first year's post-transplant costs.
Jessup suggested that another $50,000 could be added in the cost of anti-rejection drugs during the first year when those drugs are used the most in preventing the heart from rejecting the donor organ.
Those estimates add up to a $500,000 transplant-related bill at the end of the first year.
But before the former vice president got his heart, he spent 20 months with a left ventricular assist device (LVAD) – the HeartMate II. The cost of the device and the hospital stay before and after it was implanted in his chest could have cost up to $200,000, Jessup suggested.
"The hospital stay is the most expensive part of this treatment," Walsh said. She noted that the estimates were made on speculation as to how sick Cheney was when he first received the device and how long his hospital stay was. "Just the surgery and the cost of the device and the initial stay in the hospital regarding recovery after the surgery would probably be in the range of $130,000 to $140,000," she said.
On top of that are the regular visits to the hospital for checkups and maintenance which could double or triple that amount over the course of 20 months, Walsh said.
Thus LVAD total costs would add up to about $300,000.
Compared with those devices, Cheney's other heart-related problems were less costly.
Walsh suggested that the implantable cardioverter defibrillator (ICD) that was surgically sewn into his chest wall right after he took office as vice president in 2001 would have cost about $30,000. Repeated trips to the doctor to interrogate the device and the probable need for a replacement generator during the 10-year period he wore the ICD might have boosted the overall cost to around $75,000, Walsh suggested.
After one of his five heart attacks, Cheney underwent cardiac bypass surgery grafting, a standard procedure, which could cost in the neighborhood of $50,000, Walsh said, again depending on the extent of the hospital stay and the type of surgery performed.
Another of his heart attacks, involved the implantation of stents to keep occluded coronary arteries patent, with a likely cost of around $50,000 to $60,000, the doctors said.
Taken together, the ICD implantation, CABG, and stenting add another $175,000 to the total.
Walsh noted that one of Cheney's heart attacks had to be characterized as minor because it was through the use of troponin testing that his medical team was actually able to determine he had, indeed, suffered a heart attack.
"Cheney was one of the first public figures who was involved in troponin testing," she said.
That minor heart attack might not have been as expensive in health resource utilization, but the "run-of-the-mill" heart attack might run up $30,000 to $50,000 depending on recovery and time spent in intensive care and in the cardiac care units.
The tab for three heart attacks and a minor heart attack would likely cost about $100,000 in healthcare services.
"There are relatively conservative estimates," Walsh said, "So it is easy to see where his healthcare costs for end-stage heart disease would amount to more than a million dollars."
However, she said Cheney's journey from that first heart attack when he was 37 until his heart transplant surgery at age 71, is not an atypical trip in battling end-stage heart disease and heart failure.
She said many others walk that same path, as heart disease is progressive.
She also said that a million dollar health bill is far from the most expensive that one could run up, she said.
Neonates with major cardiac abnormalities can run up bills that far exceed a million dollars she said.
She also noted that some cancer-related surgeries and treatments can push costs into the million dollar brackets.
Jessup told MedPage Today that, despite the high costs, a successfully treated heart transplant patient is actually cost-effective because repeat visits to hospital for urgent heart failure can cost hundreds of thousands of dollars a year.
Walsh and Jessup emphasized that their estimates of costs are subject to numerous variables: The costs of devices can be mitigated through contracts with various agencies and hospitals; hospital and physician charges vary widely; the estimates of the costs are dependent on unknowns such as the extent of Cheney's various illnesses and the time spent in hospital and in doctors' visits; insurance payments and restrictions might also impact the final figures.
From the American Heart Association: