OBJECTIVES

: To estimate the budget impact of the introduction of a short term mechanical circulatory support device (MCS), in adult patients under 75 in post-refractory cardiogenic shock after an acute myocardial infarction (AMI); from the French payer perspective.

METHODS

: A care pathways model was developed to reflect the management of adult patients in post-cardiogenic shock after AMI. 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) or intra-aortic balloon pump (IABP), and one after the introduction of MCS in which patients can be treated with VA-ECMO, IAPB 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 literature reviews, clinical expert opinions and from a study conducted in the University Hospital Center in Bordeaux (France). Considered costs were those of each stage of the care pathway, including treatment and complication costs. Health care resource consumptions were estimated from clinical guidelines and literature or collected during the Bordeaux study. They were valued using French national tariffs databases. Deterministic sensitivity and scenario analyses were performed.

RESULTS

: From a national payer perspective, adopting MCS would produce savings of €258’413 in the first year, and €2’747’074 over 5 years, reflecting a 3% decrease of the total expenditure compared to the scenario without MCS. Main parameters that impact the results are utilization shares of MCS and its acquisition cost.

CONCLUSIONS

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