Impella vs . VA-ECMO治疗心源性休克：意大利初步成本-效果分析
IF 3
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
引用次数: 0
摘要
心源性休克（CS）是一种危及生命的心脏衰竭，需要立即治疗。尽管目前Impella®心脏泵和静脉-动脉体外膜氧合（VA-ECMO）都被广泛应用于CS患者的常规临床实践中，但缺乏关于其成本效益的广泛比较信息。本研究的目的是从意大利国家医疗保健服务（NHS）的角度比较Impella和VA-ECMO在CS患者中的成本-效果分析。第二个目标是从NHS和医院的角度比较成本。方法：采用马尔可夫模型预测生命周期（LYs）、质量调整寿命年（QALYs）以及与Impella和VA-ECMO相关的成本。国民保健制度方面的费用主要通过意大利的报销率来估计，而医院费用则来自意大利的一家临床中心。结果：从NHS的角度来看，与VA-ECMO（76,795欧元，1.391 LYs, 0.784 QALYs）相比，Impella显示出更低的成本和更好的预期寿命和患者生活质量（50,303欧元，1.544 LYs, 0.905 QALYs）。DRG对Impella的总体补偿（49,998欧元）不完全包括医院费用和技术费用（57,770欧元）。相反，VA-ECMO策略的医院费用（52,190欧元）低于NHS总体报销（76,790欧元）。结论：我们的分析表明，Impella可能比VA-ECMO节省成本，同时也为CS患者提供更好的健康结果；然而，观察到成本和偿还率存在差异，这可能是由于患者护理和医院资源利用的差异。需要未来的实际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。本文章由计算机程序翻译，如有差异，请以英文原文为准。
Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Preliminary Cost-Effectiveness Analysis in the Italian Context.
Introduction: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
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来源期刊
Cardiology and Therapy
CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
5.30
自引率
0.00%
发文量
38
审稿时长
6 weeks
期刊介绍：
Aims and Scope
Cardiology and Therapy is an international, open access, peer reviewed (single-blind), rapid-publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of cardiovascular therapies and interventions, including devices. Studies relating to diagnosis and diagnostics, pharmacoeconomics, public health, quality of life, as well as patient care, management and education are also encouraged.
Areas of focus include, but are not limited to, ischaemic heart disease and acute cardiac care, myocardial, valvular, pericardial and congenital heart disease, vascular and pulmonary disease (including hypertension), arrhythmias, heart failure, non-invasive diagnostic techniques, and invasive and interventional cardiology as well as cardiovascular surgery.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols and short communications such as commentaries and editorials. Cardiolology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals.
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The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of cardiovascular therapies.
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The journal’s dedicated in-house editorial team offer a personal “concierge service” meaning authors will always have an editorial contact able to update them on the status of their manuscript. The editorial team check all manuscripts to ensure that articles conform to the most recent COPE, GPP and ICMJE publishing guidelines. This supports the publication of ethically sound and transparent research.
Digital Features and Plain Language Summaries
Cardiology and Therapy offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by key summary points, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article. The journal also provides the option to include various types of digital features including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations. All additional features are peer reviewed to the same high standard as the article itself. If you consider that your paper would benefit from the inclusion of a digital feature, please let us know. Our editorial team are able to create high-quality slide decks and infographics in-house, and video abstracts through our partner Research Square, and would be happy to assist in any way we can. For further information about digital features, please contact the journal editor (see ‘Contact the Journal’ for email address), and see the ‘Guidelines for digital features and plain language summaries’ document under ‘Submission guidelines’.
For examples of digital features please visit our showcase page https://springerhealthcare.com/expertise/publishing-digital-features/
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Upon acceptance of your article for publication, authors will be required to pay the mandatory Rapid Service Fee of £3650/€4500/$5100. The journal will consider fee discounts for developing countries and this is decided on a case by case basis.
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All articles published by Cardiology and Therapy are published open access.
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Upon submission, manuscripts are assessed by the editorial team to ensure they fit within the aims and scope of the journal and are also checked for plagiarism. All suitable submissions are then subject to a comprehensive single-blind peer review. Reviewers are selected based on their relevant expertise and publication history in the subject area. The journal has an extensive pool of editorial and advisory board members who have been selected to assist with peer review based on the afore-mentioned criteria.
At least two extensive reviews are required to make the editorial decision, with the exception of some article types such as Commentaries, Editorials and Letters which are generally reviewed by one member of the Editorial Board. Where reviewer recommendations are conflicted, the editorial board will be contacted for further advice and a presiding decision. Manuscripts are then either accepted, rejected or authors are required to make major or minor revisions (both reviewer comments and editorial comments may need to be addressed). Once a revised manuscript is re-submitted, it is assessed along with the responses to reviewer comments and if it has been adequately revised it will be accepted for publication. Accepted manuscripts are then copyedited and typeset by the production team before online publication. Appeals against decisions following peer review are considered on a case by case basis and should be sent to the journal editor.
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