Economic evaluation of Impella versus VA-ECMO in 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), effect 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 mixed private-public Australian healthcare system. Methods 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–adjusted 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. Conclusion Based on this cost-effectiveness analysis and economic modelling, this study offers preliminary evidence that Impella® represents a cost-effective and cost-saving alternative to VA-ECMO for patients presenting with CS in a mixed public-private healthcare system.