title: Economic implications of the prophylactic use of intraaortic balloon counterpulsation in the setting of acute myocardial infarction. The Randomized IABP Study Group. Intraaortic Balloon Pump.
abstract: Intraaortic balloon counterpulsation (IABP) has been shown to improve coronary artery patency and reduce the rates of recurrent myocardial ischemia and its sequelae in selected patients when used within 24 hours of acute myocardial infarction. The economic implications of prophylactic IABP use are unknown. We obtained hospital bills for 102 patients enrolled in the Randomized IABP Trial (56%) and converted charges to costs using each hospital's Medicare cost report. In-hospital costs for patients who had 48 hours of IABP were compared with those of patients who did not. The costs of angiographic and clinical complications were determined. Small differences in clinical and angiographic characteristics existed between patients in the economic substudy and the overall population, but overall angiographic and clinical outcomes were comparable. Costs for patients who had IABP versus control patients were similar: mean $22,357 +/- $14,369 versus $19,211 +/- $8,414, median (25th and 75th percentiles) $17,903 ($15,787, $22,147) versus $17,913 ($15,144, $21,433), p = 0.45. Hospital costs were higher with the development of recurrent ischemia: mean $23,125 +/- $7,690 versus $20,416 +/- $12,449, median $21,069 ($17,896, $26,885) versus $17,492 ($14,892, $20,998) p = 0.02. Patients who had an adverse clinical event (death, stroke, reinfarction, and emergency revascularization) also had higher hospital costs: mean $25,598 +/- $10,024 versus $19,790 +/- $12,045, median $21,877 ($18,380, $28,049) versus $17,364 ($14,773, $20,779), p = 0.002. The prophylactic use of IABP in patients at high risk of infarct artery reocclusion within 24 hours of acute myocardial infarction provides sustained clinical benefit without substantially increasing hospital costs.
authors.affiliation: University of Louisville Affiliated Hospitals, Kentucky, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Talley
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: B S
authors.initials: BS
authors.lastname: George
authors.forename: J D
authors.initials: JD
authors.lastname: Leimberger
authors.forename: L G
authors.initials: LG
authors.lastname: Berdan
authors.forename: L
authors.initials: L
authors.lastname: Davidson-Ray
authors.forename: M
authors.initials: M
authors.lastname: Rawert
authors.forename: L C
authors.initials: LC
authors.lastname: Lam
authors.forename: H R
authors.initials: HR
authors.lastname: Phillips
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000191:economics; D017023:Coronary Angiography / Q000191:economics; D003331:Coronary Vessels / Q000473:pathology; D016757:Death, Sudden, Cardiac; D004630:Emergencies; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D017202:Myocardial Ischemia / Q000191:economics / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000191:economics; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014654:Vascular Patency