Cost Savings for pVAD compared to ECMO in the Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: An Episode-of-Care Analysis

Monday, May 20, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
George W. Vetrovec, M.D., MSCAI , Virginia Commonwealth University Medical Center, Richmond, VA
Michael J. Lim, M.D., FSCAI , St. Louis University School of Medicine, St. Louis, MO
Kelly A Seeger, MSPH , Baker Tilly Virchow Krause, LLP, New York, NY
Keith A Needham, MS , Baker Tilly, New York, NY

Acute myocardial infarction with cardiogenic shock (AMICS) using hemodynamic support (HS) impacts hospital costs. This study evaluated hospital costs for Medicare Fee-for-Service patients (pts) with AMICS treated with percutaneous ventricular assist device (pVAD) vs. extracorporeal membrane oxygenation (ECMO).

A retrospective claims analysis identified pts from the full census Medicare Standard Analytic File including: Inpatient, Outpatient, Skilled Nursing Facility and Home Health files. Pts with an AMICS diagnosis treated with pVAD or ECMO (index procedure between 1/1/2015-3/31/2017) were included. 1:1 Propensity Score Matching was performed based on criteria such as high-cost comorbidities. Index costs, discharge disposition (including mortality), post-index utilization, and episode-of-care (EOC) costs. EOC was defined as index admission for all pts plus a 45-day post-index period for pts who survived index.

Each cohort included 338 pts. Following index hospitalization, the average cost savings with additional inpatient care was 31% for pVAD pts ($62,188 vs. $90,087; p=NS). Index in-hospital mortality rates were 53% for pVAD vs. 64% for ECMO (178 vs. 217; p=0.0023), and total EOC in-hospital mortality rates were 66% for pVAD vs. 74% for ECMO (222 vs. 250; p= 0.0160). Table 1 details cost and index length of stay findings by cohort.

HS using pVAD for AMICS is associated with reduced mortality rates and lower hospital costs compared to ECMO, driven by a shorter index LOS, lower index facility cost, and lower post-index costs. Thus pVAD use for AMICS can reduce total EOC costs and mortality.