George Vetrovec, MD, Discusses Impella® Cost-Effectiveness

George Vetrovec, MD, professor of medicine, emeritus, at Virginia Commonwealth University, says that physicians are increasingly concerned about cost-effectiveness as they consider treatment options for patients. He discusses data showing the cost-effectiveness of percutaneous ventricular assist devices (PVADs), including Impella. Analyses of the PROTECT II randomized controlled trial demonstrated that Impella use in high-risk PCI is associated with shorter hospital stays and a reduction in repeated admission for revascularization at 90 days.^1,2

Dr. Vetrovec also discusses a 2014 paper by Stretch, et al³, which demonstrated that PVADs are associated with improved outcomes in cases of cardiogenic shock, as well as reduced costs, when compared to other treatments, including intra-aortic balloon pump (IABP). Dr. Vetrovec stresses that physicians must consider the long-term outcomes of patients when evaluating cost-effectiveness. “Sometimes trying to save costs and using the [less invasive method] sounds good, but you delay therapy,” says Dr. Vetrovec. “Then the patients are sicker, and they don’t do as well. And it costs even more. Sometimes spending a little more up front gives you a better long-term outcome, and less total cost.”

Dr. Vetrovec also discusses the importance of methodology when studying cost-effectiveness, highlighting the need to do propensity matching so that similar groups of patients are being compared, and to ensure that the difference in outcomes is related to the therapy itself and not characteristics of the patient population. “The strongest studies are the ones that match patients for similar risk factors,” says Dr. Vetrovec. He also notes that it can be difficult to get samples that are not biased by changes in best practices in patient management over time.