ArticleEuropean heart journal open2026
Cost-effectiveness of combined veno-arterial extracorporeal membrane oxygenation and Impella support (ECPELLA) in infarct-related cardiogenic shock.
Article in European heart journal open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Aims: Cardiogenic shock carries high early mortality. Combined veno-arterial extracorporeal membrane oxygenation and Impella support (ECPELLA) may improve outcomes but is costly and unevenly available across Europe. Its incremental clinical and economic value compared with guideline-directed medical therapy (GDMT) remains uncertain. Methods: We developed a calibrated partitioned-survival model comparing ECPELLA with GDMT over a 10-year horizon from a statutory health insurance payer perspective (2024€ reference costing environment). Costs, utilities, and survival inputs were derived from contemporary randomized trials and multinational registries. Uncertainty was assessed using probabilistic, deterministic, scenario, and value-of-information analyses. European cost-environment scenarios were explored to assess transferability. Results: ECPELLA yielded 4.05 quality-adjusted life-years (QALYs) at €195 000 vs. 3.10 QALYs at €95 000 for GDMT (incremental cost €100 000; incremental QALY 0.95), resulting in an incremental cost-effectiveness ratio (ICER) of €105 263 per QALY. Device and intensive care unit (ICU) costs and early survival effects were the main drivers of uncertainty. Cost-effectiveness improved in patients younger than 60 years, those with reversible myocardial dysfunction, early cannulation, and treatment in high-volume centres (ICER €60 000-80 000 per QALY), whereas neutral survival effects produced ICERs exceeding €300 000 per QALY. Value-of-information analysis indicated residual decision uncertainty. Conclusion: ECPELLA increased quality-adjusted survival at higher cost. In the base-case analysis, the ICER was €105 263 per QALY gained. In predefined scenario analyses, ICERs were lower in younger patients, those with recovery potential, early cannulation, and high-volume centres. Residual decision uncertainty was observed in value-of-information analyses.
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