Rognoni Carla, Ardito Vittoria, La Fauci Dario, Pieri Marina, Scandroglio Anna Mara, Tarricone Rosanna
Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy.
Operations Management, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Cardiol Ther. 2025 Jun;14(2):183-198. doi: 10.1007/s40119-025-00404-w. Epub 2025 Mar 28.
Cardiogenic shock (CS) is a life-threatening failure of the heart to supply adequate blood, requiring immediate treatment. Although nowadays Impella heart pumps and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) are both widely employed in routine clinical practice for the management of patients with CS, extensive comparative information on their cost-effectiveness is lacking. The aim of the present study was to conduct a cost-effectiveness analysis comparing Impella to VA-ECMO in patients with CS from the National Healthcare Service (NHS) perspective in Italy. A secondary objective was to compare costs from both NHS and hospital perspectives.
A Markov model projected, on a lifetime horizon, life years (LYs), quality-adjusted life years (QALYs), and costs associated with Impella and VA-ECMO. Costs from the NHS perspective were estimated mainly through Italian reimbursement rates, while hospital costs were derived from a clinical center in Italy.
From an NHS perspective, Impella showed lower costs and better life expectancy and patients' quality of life (€50,303, 1.544 LYs, 0.905 QALYs) compared to VA-ECMO (€76,795, 1.391 LYs, 0.784 QALYs). DRG overall reimbursements for Impella (€49,998) do not completely cover the hospital costs and the cost for the technology (€57,770). Conversely, the hospital cost for the strategy VA-ECMO (€52,190) is lower than the NHS overall reimbursements (€76,790).
Our analysis suggests that Impella may be cost-saving over VA-ECMO, while also providing better health outcomes for patients with CS; however, discrepancies in costs and reimbursement rates were observed, likely due to variability in patient care and hospital resource utilization. Future real-world studies are needed to confirm these findings, but decision-makers can use this data as an initial reference for health technology assessments in Italy.
心源性休克（CS）是一种危及生命的心脏功能衰竭，无法提供足够的血液，需要立即治疗。尽管如今Impella心脏泵和静脉-动脉体外膜肺氧合（VA-ECMO）在CS患者的常规临床治疗中都被广泛应用，但关于它们成本效益的广泛比较信息却很缺乏。本研究的目的是从意大利国家医疗服务体系（NHS）的角度，对Impella和VA-ECMO在CS患者中的应用进行成本效益分析比较。第二个目标是比较NHS和医院两个角度的成本。
一个马尔可夫模型在终生范围内预测了Impella和VA-ECMO相关的生命年（LYs）、质量调整生命年（QALYs）和成本。NHS角度的成本主要通过意大利的报销率估算，而医院成本则来自意大利的一个临床中心。
从NHS角度来看，与VA-ECMO（76,795欧元，1.391个生命年，0.784个质量调整生命年）相比，Impella显示出更低的成本以及更好的预期寿命和患者生活质量（50,303欧元，1.544个生命年，0.905个质量调整生命年）。Impella的诊断相关组（DRG）总体报销费用（49,998欧元）并不能完全覆盖医院成本和技术成本（57,770欧元）。相反，VA-ECMO策略的医院成本（52,190欧元）低于NHS的总体报销费用（76,790欧元）。
我们的分析表明，Impella可能比VA-ECMO节省成本，同时也能为CS患者提供更好的健康结果；然而，观察到成本和报销率存在差异，这可能是由于患者护理和医院资源利用的差异所致。未来需要进行真实世界研究来证实这些发现，但决策者可以将这些数据作为意大利卫生技术评估的初步参考。
