OBJECTIVES

: To estimate the budget impact of the introduction of a short term mechanical circulatory support device (MCS), in adult patients under 65 suffering from left-ventricular dysfunction (LVD) in refractory post-cardiogenic shock; from the French payer perspective.

METHODS

: A care pathways model was developed to simulate the management of adult patients suffering from LVD in post-cardiogenic shock. In order to estimate the financial impact of MCS adoption over a 5 years period in France, two scenarios were compared: one representing current clinical practice in which patients are treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only, and one after the introduction of MCS in which patients can be treated with VA-ECMO or MCS. The care pathways have been developed based on clinical guidelines, expected position of MCS in the therapeutic strategy, and opinions of six French clinicians. Transition probabilities were estimated from a study conducted in the University Hospital Center in Bordeaux (France) (55 patients treated with MCS between 2011-2017), literature reviews and clinical expert opinions. Considered costs were those of each stage of the care pathway, including both treatment and complication costs. Health care consumptions were collected during the Bordeaux study or estimated from clinical guidelines and literature and were valued using French databases. Deterministic sensitivity and scenario analyses were performed.

RESULTS

: From a French national payer perspective, adopting MCS would produce savings of €375’639 in the first year, and €4’319’848 over 5 years, reflecting a 5% decrease of the total expenditure compared to the scenario without MCS. Main parameters that impact the results are utilization shares of MCS and cost of MCS.

CONCLUSIONS

: This study represents the first budget impact model that accurately describes the care pathways of an adult patient suffering from LVD in post-cardiogenic shock with and without MCS. Adopting MCS would result in savings from the first year onwards.