Abstract 4708: Cost-effectiveness of an Early Revascularization Strategy for Cardiogenic Shock Based on Long-term Outcomes
Introduction: Cardiogenic shock (CS) is a significant cause of death in patients hospitalized with acute myocardial infarction (AMI). A survival benefit exists with early revascularization (ERV) versus initial medical stabilization with clinically selected delayed revascularization (IMS) in patients presenting with AMI complicated by CS (13 lives saved per 100 patients treated). No studies have evaluated medical cost versus health benefit tradeoffs in this subpopulation. Cost data may be used to reinforce clinical outcomes already published from the SHould We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial, and promote further implementation of best practice medicine.
Hypothesis: We assessed the hypothesis that although ERV is associated with higher medical costs compared to IMS, improved survival is achieved in patients with AMI complicated by CS, at a cost per life-year saved (LYS) that lies within previously accepted benchmarks.
Methods: The SHOCK trial is an international randomized clinical trial that enrolled 302 patients with AMI complicated by CS. Survival and resource use information were obtained from trial records, and medical cost weights from secondary sources with up to an 11-year follow up.
Results: Average medical costs through the follow-up period were $67,788 for the ERV group and $47,594 for the IMS group (difference $20,193; 95% CI $9,310-$32,759; p<0.001). Mean survival time for ERV was 2.464 years versus 1.635 years for IMS (difference 0.829; 95% CI 0.172–1.500; p=0.008). Incremental medical cost per LYS after discounting at 3% per annum was $30,857. A treatment strategy involving ERV versus IMS was associated with increased survival in 993 of 1,000 samples, with a cost-effectiveness ratio of <$100,000 per LYS in 95.5% of samples and <$50,000 per LYS in 81.7% of samples.
Conclusion: In conclusion, ERV was associated with a significantly higher cost of care and an increased mean survival time, when compared to IMS. This benefit, in terms of cost per LYS, makes ERV economically attractive by conventional standards.