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Abstract
This article systematically appraises the findings and conclusions derived from six recent studies of the economic impact and relative value of using percutaneous ventricular assist devices to render short-term hemodynamic support to high-risk patients with particular attention to the settings of cardiogenic shock and percutaneous coronary interventions. Although the extant body of literature is still growing, these studies offer evidence and insight regarding the health economics of traditional and emerging technologies in this treatment domain, and generally find the latter to be cost-effective in the long term. As the incidence of heart disease rises and the attendant economic burden of healthcare climbs, technologies for mitigating cardiovascular illness will be the target for more robust empirical evidence to justify the comparative value of minimally invasive hemodynamic support interventions in the armamentarium of treatment options available to physicians.
Acknowledgements
We thank D Buck and C Cool of ParenteBeard and Danielle Libersan for their help in preparing the manuscript.
Financial & competing interests disclosure
B Maini has received speakers bureau honoraria from ABIOMED, Medtronic, Abbott, SJM. DJ Scotti and D Gregory are paid advisors of ABIOMED. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
In a dynamic budget impact model based on a 24 million member commercial dataset, the introduction of percutaneous ventricular assist device (pVAD) to high-risk cardiac patients who had received mechanical hemodynamic support with intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation or extracorporeal left ventricular assist device resulted in a net cost savings on both a plan level and on a per member per month level across the adoption penetration spectrum, which ranged from 10 to 60%.
In addition to being cost sparing, pVAD appears to be cost-effective in patients with cardiogenic shock (CS) as its use was associated with a higher discharge survival rate and shorter length of index stay when compared with other more invasive forms of mechanical hemodynamic support (extracorporeal membrane oxygenation and extracorporeal left ventricular assist device with or without IABP).
The cost-effectiveness of pVAD in patients with CS was supported using a variety of sources including MedPAR, national commercial claims data and data derived from patients on a protocol-guided pVAD therapy.
In patients considered at high cardiac risk and undergoing a percutaneous coronary intervention, pVAD, specifically Impella® 2.5, also appears to be cost-effective when compared with IABP with an incremental cost-effectiveness ratio of approximately US$40,000 per quality-adjusted life-year, which is well below the standard willingness-to-pay threshold.
Similar to the CS population, the cost-effectiveness of pVAD in high-risk cardiac patients undergoing a percutaneous coronary intervention was supported using a variety of Impella 2.5 sources including a US-based pVAD registry (USpella), a European-based pVAD registry (Europella) and claims data collected from patients participating in a randomized clinical trial (PROTECT II).
pVAD use (specifically Impella 2.5) has been associated with hospital length of stay and post-index cost reductions across numerous studies positioning it as a high-value technology in an era of accountable care.