Cost-effectiveness of microaxial flow pump versus standard of Care in the management of Cardiogenic shock in Spain

BACKGROUND: Cardiogenic shock (CS) remains the leading cause of death in patients with ST-elevation myocardial infarction (STEMI) despite timely revascularization and advances in pharmacological therapy. This study assessed the cost-effectiveness of a microaxial flow pump (mAFP) plus standard of care (SoC) versus SoC alone in patients with STEMI complicated by CS from the perspective of the Spanish National Health System (NHS). RESEARCH DESIGN AND METHODS: A cost-effectiveness analysis was conducted using a partitioned survival model over a lifetime horizon. Clinical efficacy inputs were derived from DanGer Shock trial, while adverse and long-term clinical events were obtained from DanGer Shock and literature. Direct healthcare costs (expressed in 2025 euros), including device acquisition, hospitalization, adverse and clinical events management, and cardiac rehabilitation. RESULTS: In the base-case analysis, mAFP+SoC yielded 3.430 life-years gained (LYG) and 2.645 quality-adjusted life-years (QALY) per patient, compared with 1.657 LYG and 1.272 QALYs with SoC alone. Total costs were €51,980 and €17,008, respectively, resulting in an incremental cost-utility ratio of 25,468/QALY. Deterministic and probabilistic sensitivity analyses supported model robustness. CONCLUSIONS: From the Spanish NHS perspective, mAFP+SoC could be a cost-effective strategy for STEMI-CS, providing substantial gains in survival and health-related quality of life at a reasonable incremental cost.