Author + information
Previous research has demonstrated the cost-effectiveness of pVAD hemodynamic support for patients undergoing high-risk percutaneous coronary intervention (PCI) and for patients in profound cardiogenic shock (CS). As providers develop into Accountable Care Organizations (ACOs), there are several lessons to be learned from managed care budget impact models (BIMs) that guide clinical decisions. The objective of this study was to estimate the incremental budgetary change in per-member-per-month (PMPM) costs for percutaneous ventricular assist devices (pVADs) in these important patient populations.
Claims data for the model were from a national commercial payer database containing 25 MM members for the period of 2009-2010. A dynamic BIM was developed to show the net and incremental effects of pVAD adoption on commercial claim costs. Sensitivity analyses were conducted to show various rates of conversion from traditional hemodynamic support alternatives to pVADs.
In the CS cohort, prevalence for surgical alternatives was negligible (0.00193 index admits per thousand members), while pVAD prevalence was 0.00145. Aggregating all claim costs across the entire one-year episode of care, the costs of surgical alternatives were more than double those of pVAD ($516,593 vs. $280,014, p=0.004), driven largely by index admission costs. On a PMPM basis, the cost for surgical alternatives was $0.05 PMPM, and $0.02 PMPM for pVADs. These savings offset the incremental cost of pVAD therapy in the high-risk PCI cohort (IABP = $102,215, pVAD = $138,334). In that cohort, prevalence for IABP treatment was 0.02241 per thousand, while PVAD prevalence was 0.00197. A 50% conversion of surgical cases to pVAD yields a $5.7MM savings for the CS population ($0.01 PMPM); a 30% conversion of IABP cases to pVAD in the HR-PCI population will cost an additional $6MM ($0.01 PMPM). Subgroup analyses will be presented.
In an era of population health management, BIM analyses for emerging technologies can aid ACOs in decision-making. This study demonstrates that pVAD technology has a minimal PMPM impact across different patient populations and throughout a technology adoption curve.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Mechanical Circulatory Support
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1260M-270
- 2013 American College of Cardiology Foundation