title: Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives: cost-effectiveness in the emergent setting.
abstract: This study evaluates the cost-effectiveness of percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives.
  
  
  BACKGROUND
  Previous research has demonstrated the cost-effectiveness of pVAD hemodynamic support for patients undergoing high-risk percutaneous coronary intervention. For patients in cardiogenic shock (CS), use of pVAD therapy has been shown to reduce length of stay (LOS).
  
  
  METHODS
  National utilization and outcome data from the 2010-2011 MedPAR and state-sponsored all-payer databases were collected for patients with an acute myocardial infarction complicated by CS who were treated with either a pVAD (n = 883) or with traditional surgical hemodynamic support alternatives (ECMO and extracorporeal VAD) (n = 305).
  
  
  RESULTS
  Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.001) and was achieved with a strong trend toward reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a significantly lower cost of the index admission ($90,929 and $144,257, respectively, P < 0.001). Cost-effectiveness analysis based on the national data demonstrated that pVAD achieved improved outcomes at lower cost. Data were also collected for similar patients who underwent protocol-guided pVAD therapy (using Impella 2.5) at PinnacleHealth, between 2009 and 2011 (n = 30). At this site, the survival rate increased to 60%, length of hospitalization was shortened to 6 days, and admission costs were lowered to $53,850 relative to the surgical alternatives strategy.
  
  
  CONCLUSIONS
  For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population.
authors.affiliation: PinnacleHealth, Harrisburg, Pennsylvania.
authors.forename: Brijeshwar
authors.initials: B
authors.lastname: Maini
authors.forename: David
authors.initials: D
authors.lastname: Gregory
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Scotti
authors.forename: Larisa
authors.initials: L
authors.lastname: Buyantseva
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000401:mortality; D016507:Cardiology Service, Hospital / Q000191:economics*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D006353:Heart-Assist Devices / Q000191:economics*; D006439:Hemodynamics; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D018803:Models, Economic; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010351:Patient Discharge / Q000191:economics; D010414:Pennsylvania; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: angioplasty; cardiogenic shock; cost-effectiveness analysis; length of stay; myocardial infarction; pVAD