Cost-Effectiveness of Impella Versus Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocardial Infarction Cardiogenic Shock.

BACKGROUND

Recent trial data support the use of the Impella heart pump for the management of patients with cardiogenic shock (CS). However, questions regarding the cost-effectiveness of Impella compared with alternative mechanical circulatory support (MCS), such as venoarterial extracorporeal membrane oxygenation (VA-ECMO), affect adoption. In this study, we evaluated the cost-effectiveness of Impella versus VA-ECMO among patients requiring MCS for CS, from the perspective of the Australian healthcare system.

METHOD: A survival analysis was constructed to estimate cost-effectiveness. Survivors were assigned costs and outcomes over a lifetime time horizon. Clinical inputs were derived from a meta-analysis of propensity score-matched studies comparing Impella with VA-ECMO. Health care resource use and unit costs were included consistent with the Australian health care system perspective. Utility weights were applied to surviving patients to calculate quality-adjusted life-years (QALY), and both costs and outcomes were discounted at an annual rate of 5%.

RESULTS

In the base-case, Impella was associated with cost savings of Australian dollars (AUD) $30,157 per person, 2.798 additional life years, and 1.206 additional QALYs compared with VA-ECMO. At a willingness-to-pay threshold of AUD $50,000 per QALY, the estimated net monetary benefit was AUD $90,450. Sensitivity analyses demonstrated that results were most influenced by short-term mortality, daily hospital costs, and length of stay.

CONCLUSIONS

This cost-effectiveness analysis and economic modelling suggests that targeted use of Impella represents a cost-saving technology compared to VA-ECMO for the management of CS, which may offer both clinical and economic benefits from the perspective of the Australian healthcare system.