Economic implications of intra-aortic balloon support for myocardial infarction with cardiogenic shock: an analysis from the IABP-SHOCK II-trial.

Abstract

The Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial has demonstrated the safety of intra-aortic balloon (IABP) support in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, but no beneficial effect on mortality. Currently, intra-aortic balloon pumping is still the most widely used support device. However, little is known about the economic implications associated with this device. Data of 600 patients included in the IABP-SHOCK II trial (registered at ClinicalTrials.gov, NCT00491036) with follow-up at 30 days, 6 and 12 months were subjected to an economic analysis. Patients with cardiogenic shock complicating AMI were randomly assigned to IABP additionally to optimal medical therapy (OMT; n = 301) or OMT alone (n = 299) before early revascularization. Costs were calculated from the perspective of a German healthcare payer. Cost-effectiveness and cost-utility analyses were performed using quality-adjusted life years (QALY) and reduction in New York Heart Association (NYHA) and Canadian Cardiac Society (CCS) class as effectiveness measures. There was a statistically significant difference in overall costs between the IABP (33,155 ± 14,593 <euro>) and the control group (32,538 ± 14,031 <euro>, p < 0.00001). This was predominantly attributed to the IABP costs in the IABP (760 ± 174 <euro>) versus control group (64 ± 218 <euro>, p < 0.0001) whilst the intensive care unit costs did not differ between the groups (29,177 ± 12,013 <euro> and 29,401 ± 12,063 <euro>, p = 0.82). There was no significant difference in QALY or NYHA and CCS reduction, respectively (p = n.s.). IABP support is associated with higher healthcare costs as compared to conservative treatment regimens. Clinically, IABP support cannot generally be recommended in AMI complicated by cardiogenic shock in the absence of a mortality benefit. However, economically considering the relatively little contribution to overall costs generated by IABP therapy it may still be considered if clinical scenarios with an IABP-induced benefit may be identified in the future.