Clinical and economic effectiveness of percutaneous ventricular assist devices for high-risk patients undergoing percutaneous coronary intervention.
BACKGROUND
Comparative effectiveness research (CER) is taking a more prominent role in formalizing hospital treatment protocols and health-care coverage policies by having health-care providers consider the impact of new devices on costs and outcomes. CER balances the need for innovation with fiscal responsibility and evidence-based care. This study compared the clinical and economic impact of percutaneous ventricular assist devices (pVAD) with intraaortic balloon pumps for high-risk patients undergoing percutaneous coronary intervention (PCI).


METHODS
This study conducted a review of all comparative randomized control trials of the pVADS (Impella and TandemHeart) vs IABP for patients undergoing high-risk percutaneous coronary intervention (PCI). A retrospective analysis of the 2010 and 2011 Medicare MEDPAR data files was also performed to compare procedural costs and hospital length of stay (LOS). Readmission rates between the devices were also studied.


RESULTS
Based on available trials, there is no significant clinical benefit with pVAD compared to IABP. Use of pVADs is associated with increased length of Intensive Care Unit stay and a total longer LOS. The incremental budget impact for pVADs was $33,957,839 for the United States hospital system (2010-2011).


CONCLUSIONS
pVADs are not associated with improved clinical outcomes, reduced hospital length of stay, or reduced readmission rates. Management of high-risk PCI and cardiogenic shock patients with IABP is more cost effective than a routine use of pVADS. Use of IABP as initial therapy in high-risk PCI and cardiogenic shock patients may result in savings of up to $2.5 billion annually of incremental costs to the hospital system.
The University of Chicago, 5841 South Maryland, MC 6080, Chicago, IL 60637 USA. ashah5@uchicago.edu.
Atman P
AP
Shah
Elizabeth M
EM
Retzer
Sandeep
S
Nathan
Jonathan D
JD
Paul
Janet
J
Friant
Karin E
KE
Dill
Joseph L
JL
Thomas
D003362:Cost-Benefit Analysis; D006353:Heart-Assist Devices / Q000191:economics*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000191:economics* / Q000628:therapy*; D014481:United States