title: Economic and operational implications of a standardized approach to hemodynamic support therapy using percutaneous cardiac assist devices.
abstract: OBJECTIVE
  Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.5 and intra-aortic balloon pump (IABP) support.
  
  
  METHODS
  All high-risk patients who received Impella 2.5 (n = 35) and IABP (n = 295) support from December 2008 to July 2011 were included. Propensity score matching identified a balanced 1:1 matched cohort (35 Impella vs 35 IABP) based on indications for implantation, preimplantation hemodynamics, and age. Diagnostic, procedural, financial, and resource use data were collected.
  
  
  RESULTS
  As compared with IABP, Impella offered a more predictable course of treatment/resource consumption and was not associated with any extreme cost outliers (17.1% vs 0.0%, respectively; P = 0.025). The mean admission and 90-day episode of care total costs for Impella were 5.5% ($67,681 vs $71,608, P = 0.79) and 4.2% ($70,680 vs $73,476, P = 0.85) lesser than that for IABP, respectively. Although not statistically significant, Impella patients had a trend toward lower rehospitalization rates (11.4% vs 20%), lesser mean index length of hospital stay (11.2 vs 13.7), and 90-day (11.7 vs 14.2) episode of care length of hospital stay.
  
  
  CONCLUSIONS
  Impella support was associated with consistent course of treatment/resource consumption with significantly fewer 90-day extreme cost outliers than was IABP. The lower index and 90-day follow-up cost trends observed for Impella were driven by shorter length of hospital stay and fewer rehospitalizations. As providers strive to improve quality of care by reducing variability, these findings have implications for the development of hemodynamic support algorithms.
authors.affiliation: From the *Division of Interventional Cardiology, Department of Cardiology, Frederik Meijer Heart & Vascular Institute, Grand Rapids, MI USA; †Division of Cardiology, Spectrum Health, Grand Rapids, MI USA; ‡Internal Medicine Residency, Grand Rapids Medical Education Partners/ Michigan State University Program, Grand Rapids, MI USA; §Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI USA; ∥Department of Surgery, Michigan State University, Grand Rapids, MI USA; ¶Internal Medicine Hospitalist, Spectrum Health, Grand Rapids, MI USA; #Michigan State University-College of Human Medicine, East Lansing, MI USA; **Department of Research, Spectrum Health, Grand Rapids, MI USA; ††Department of Management, Fairleigh Dickinson University, Teaneck, NJ USA; and ‡‡Prescott Associates, Avon, CT USA.
authors.forename: David
authors.initials: D
authors.lastname: Wohns
authors.forename: Purushothaman
authors.initials: P
authors.lastname: Muthusamy
authors.forename: Alan T
authors.initials: AT
authors.lastname: Davis
authors.forename: Mohsin
authors.initials: M
authors.lastname: Khan
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Postma
authors.forename: Elbert E
authors.initials: EE
authors.lastname: Williams
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Gile
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Scotti
authors.forename: David
authors.initials: D
authors.lastname: Gregory
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D006353:Heart-Assist Devices / Q000191:economics* / Q000592:standards; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000191:economics / Q000295:instrumentation*; D008297:Male; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome