November 13, 2019
Abiomed Announces Clinical Review Demonstrating Cost-Effectiveness of Impella in High-Risk PCI and Cardiogenic Shock
November 14, 2019—Abiomed announced the publication of a comprehensive review of cost and comparative effectiveness data for its Impella device. The data is a collection of the United States and European evidence published between 2004 to 2019. It includes data from the PROTECT II trial, the Centers for Medicare & Medicaid Services MedPAR database, and more than 20 peer-reviewed studies on cost-effectiveness.
Abiomed noted that these data demonstrate that the use of Impella in cases of high-risk PCI and cardiogenic shock is associated with improved patient outcomes and reduced costs when compared with an intra-aortic balloon pump (IABP) or other therapies. In the company’s announcement, they highlighted three ways the device improves cost-effectiveness: (1) reduction in mortality and cost; (2) reduction in length of stay and readmissions; and (3) reduction in long-term health care costs.
REDUCTION IN MORTALITY AND COST
Several studies found that the use of percutaneous ventricular assist devices (PVADs), including Impella, is particularly cost-effective in cases of cardiogenic shock. Stretch et al found PVADs reduced costs in cases of cardiogenetic shock in coronary atherosclerosis and other heart diseases by $45,000 and $54,000, respectively. The study also showed a 58% reduction in mortality. Maini et al found the use of PVADs (particularly the Impella 2.5) for cases of cardiogenic shock requiring emergent hemodynamic support, resulted in better outcomes, shorter length of stay, lower costs, and a survival benefit when compared with surgical hemodynamic support alternatives. Additionally, Vetrovec et al reinforced these findings showing reduced mortality rates, shorter length of stay, and lower hospital costs for PVAD use when compared with extracorporeal membrane oxygenation. This study found using PVADs yielded total episode-of-care savings of $54,571.
REDUCTION IN LENGTH OF STAY AND READMISSIONS
Abiomed stated that several studies have demonstrated that the use of the Impella device is associated with a reduction in length of stay for patients, with a greater opportunity for benefit as the illness level increases. The company highlighted several peer-reviewed studies that showed Impella use is associated:
- Gregory et al showed a 52% reduction in repeated admission for revascularization at 90 days via an independent economic analysis of the PROTECT II trial
- Maini et al found a reduction in hospital stays ranging from 2 to 12 days
- Aryana et al demonstrated shorter ablation times and reduced hospital length of stay in patients with unstable ventricular tachycardia
- Silver et al reported a reduction in acute kidney injury, with average cost savings of $22,023 per case
Abiomed also noted in their announcement that these data are consistent in the United States and Europe. A retrospective cost-effectiveness analysis by Roos et al used the USPella and Europella databases and found Impella to be a cost-effective intervention compared with IABP for high-risk PCI patients.
REDUCTION IN LONG-TERM HEALTH CARE COSTS
According to Abiomed, because Impella enables the heart to rest and recover, while aiding to restore native heart function, it may prevent patients from needing an implantable left ventricular assist device or a heart transplant. Citing United States transplant data by research firm Milliman, Abiomed notes this could lead to an estimated $887,000 reduction in hospital charges over the period from 30 days pretransplant to 180 days posttransplant discharge.