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

Background
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).

Methods
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.

Results
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.

Conclusions
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.