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Analysis: IABP more cost-effective than routine use of percutaneous VADs
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In high-risk patients undergoing primary PCI, use of percutaneous ventricular assist devices was not associated with improved clinical outcomes, reduced length of stay or decreased readmission rates compared with intra-aortic balloon pumps, according to a review of comparative randomized controlled trials.
A team of researchers analyzed all randomized controlled trials comparing percutaneous ventricular assist devices (PVADs) such as the TandemHeart (CardiacAssist) and Impella (Abiomed) devices vs. intra-aortic balloon pumps (IABP) in high-risk patients undergoing primary PCI.
Results indicated no significant clinical benefit associated with PVADs. Two trials that studied the TandemHeart vs. IABP in patients with cardiogenic shock demonstrated improved hemodynamic parameters in the PVAD group, but no substantial benefit in 30-day survival. Bleeding and limb ischemia also were increased among patients who received the TandemHeart.
In a randomized trial that compared the Impella 2.5 vs. IABP in patients with cardiogenic shock, use of the PVAD did not improve 30-day survival or hemodynamic parameters at 2 hours. The prospective, randomized PROTECT II study evaluated the Impella 2.5 vs. IABP in patients undergoing high-risk PCI and was stopped early after data failed to demonstrate differences in the primary endpoint of 30-day major adverse events.
Using Medicare MEDPAR data from 2010-2011, the researchers also performed an economic analysis of 10,261 patients who received IABP and 1,119 who received the TandemHeart or Impella devices. The mean length of stay for the PVAD group was 10.7 days vs. 8.5 days for the IABP group, and the mean length of stay in the ICU was 8.74 days vs. 7.11 days, respectively (P < .001 for both). Based on available data, the incremental budget impact associated with PVADs is $33,957,839 to the entire U.S. hospital system and approximately $109 million to the payer system. Increased supplies and equipment, greater use of blood products, laboratory charges and higher use of the operating room were identified as associated costs of PVADs.
Results also yielded no difference in cardiac readmissions in an analysis of patients who received IABP or PVADs.
“Management of high-risk PCI and cardiogenic shock patients with IABP is more cost effective than routine use of PVADs,” the researchers concluded. “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.” – by Rob Volansky
Disclosure: One researcher reports associations with Maquet Cardiovascular; the other researchers report no relevant financial disclosures.
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