Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease.

BACKGROUND: The endoscopic radiofrequency procedure (Stretta) has been used for more than a decade to treat patients with gastroesophageal reflux disease (GERD). However, the efficacy of the procedure in improving objective and subjective clinical endpoints needs to be further established. AIM: To determine the efficacy of the Stretta procedure in treating patients with GERD, using a systematic review and meta-analysis of controlled and cohort studies. METHODS: We conducted a systematic search of the PubMed and Cochrane databases for English language clinical studies of the Stretta procedure, published from inception until May 2016. Randomized controlled trials (RCTs) and cohort studies that included the use of the Stretta procedure in GERD patients were included. A generalized inverse weighting was used for all outcomes. Results were calculated by both fixed effects and random effects model. RESULTS: Twenty-eight studies (4 RCTs, 23 cohort studies, and 1 registry) representing 2468 unique Stretta patients were included in the meta-analysis. The (unweighted) mean follow-up time for the 28 studies was 25.4 [14.0, 36.7] months. The pooled results showed that the Stretta reduced (improved) the health-related quality of life score by -14.6 [-16.48, -12.73] (P < 0.001). Stretta also reduced (improved) the pooled heartburn standardized score by -1.53 [-1.97, -1.09] (P < 0.001). After Stretta treatment, only 49% of the patients using proton pump inhibitors (PPIs) at baseline required PPIs at follow-up (P < 0.001). The Stretta treatment reduced the incidence of erosive esophagitis by 24% (P < 0.001) and reduced esophageal acid exposure by a mean of -3.01 [-3.72, -2.30] (P < 0.001). Lower esophageal sphincter (LES) basal pressure was increased post Stretta therapy by a mean of 1.73 [-0.29, 3.74] mmHg (P = NS). CONCLUSIONS: The Stretta procedure significantly improves subjective and objective clinical endpoints, except LES basal pressure, and therefore should be considered as a viable alternative in managing GERD.

Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

PURPOSE: A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. DESIGN AND METHODOLOGY: A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. RESULTS: At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. CONCLUSION: Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

Operational Implications of Utilizing 2 Advanced Technologies for Rendering Short-term Hemodynamic Support to Patients Presenting With Cardiogenic Shock: A View Through the Lens of Hospital Readmissions.

PURPOSE: Reducing hospital readmissions for critically ill patients is of concern to payers and providers alike. Patients in cardiogenic shock are often treated with devices to help support the functions of the heart while the patient undergoes treatment. This study compares the readmission experience of Medicare beneficiaries treated for cardiogenic shock (CS) using percutaneous ventricular assist devices (pVADs) vs. extracorporeal membrane oxygenation (ECMO), two types of advanced cardiac support devices. Hospital readmission is a surrogate for quality and cost. DESIGN AND METHODOLOGY: A retrospective comparison of readmission patterns of patients treated for CS using two advanced cardiac support devices during calendar years 2011 and 2012 was captured via the Medicare Inpatient Standard Analytic File (100% census file). A total of 649 eligible cases (pVAD, 517; ECMO, 132) with 90 days of follow-up documentation were included in this analysis. Baseline characteristics were compared, including demographics, admission type, and severity of illness, with the 2 groups generating clinically similar baseline profiles. Primary outcomes include 30- and 90-day readmissions, associated length of stay (LOS), and costs. RESULTS: At 90 days after initial hospitalization, the readmission rates in the pVAD and ECMO cohorts were 38.7% (200/517) and 53.0% (70/132), respectively. Overall, pVAD was associated with a 27.1% reduction in readmission (P = .004). With the use of pVAD, 90-day readmission costs were lower by $12,294 ($32,736 vs $20,442, a reduction of 37.6%, P=.02) and readmission LOS was shorter by approximately 8 days, (20.5 vs. 12.7 days, a 37.9% reduction, P = .002). Similar trends were observed at 30 days; however, only LOS was significantly reduced, by 7.0 days (P < .001). CONCLUSION: In clinically comparable cohorts, pVADs were associated with reduced risk of rehospitalization, lower cost, and shorter LOS, resulting in cost savings for payers and providers. Increased adoption of pVAD, as a technology to support patients in cardiogenic shock, may help hospitals deliver greater value to both government and commercial payers.

Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives: cost-effectiveness in the emergent setting.

UNLABELLED: This study evaluates the cost-effectiveness of percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives. BACKGROUND: Previous research has demonstrated the cost-effectiveness of pVAD hemodynamic support for patients undergoing high-risk percutaneous coronary intervention. For patients in cardiogenic shock (CS), use of pVAD therapy has been shown to reduce length of stay (LOS). METHODS: National utilization and outcome data from the 2010-2011 MedPAR and state-sponsored all-payer databases were collected for patients with an acute myocardial infarction complicated by CS who were treated with either a pVAD (n = 883) or with traditional surgical hemodynamic support alternatives (ECMO and extracorporeal VAD) (n = 305). RESULTS: Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.001) and was achieved with a strong trend toward reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a significantly lower cost of the index admission ($90,929 and $144,257, respectively, P < 0.001). Cost-effectiveness analysis based on the national data demonstrated that pVAD achieved improved outcomes at lower cost. Data were also collected for similar patients who underwent protocol-guided pVAD therapy (using Impella 2.5) at PinnacleHealth, between 2009 and 2011 (n = 30). At this site, the survival rate increased to 60%, length of hospitalization was shortened to 6 days, and admission costs were lowered to $53,850 relative to the surgical alternatives strategy. CONCLUSIONS: For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population.

Linkages between organization climate and work outcomes: perceptual differences among health service professionals as a function of customer contact intensity.

The delivery of high-quality service, rendered by health service professionals who interact with customers (patients), increases the likelihood that customers will form positive evaluations of the quality of their service encounters as well as high levels of customer satisfaction. Using linkage theory to develop our conceptual framework, we identify four clusters of variables which contribute to a chain of sequential events that connect organization climate to personal and operational work outcomes. We then examine the perceptual differences of service professionals, grouped by intensity of customer contact, with respect to these variables. National data for this project were obtained from multiple sources made available by the Veterans Healthcare Administration (VHA). Cross-group differences were tested using a series of variance analyses. The results indicate that level of customer-contact intensity plays a significant role in explaining variation in perceptions of support staff, clinical practitioners, and nurses at the multivariate and univariate levels of analysis. Contact intensity appears to be a core determinant of the nature of work performed by health service professionals as well as their psychological responses to organizational and customer-related dynamics. Health service professionals are important resources because of their specialized knowledge, labor expense, and scarcity. Based on findings from our research, managers are advised to survey employees' perceptions of their organizational environment and design practices that respond to the unique viewpoints of each of the professional groups identified in this study. Such tailoring should help executives maximize the value of investments in human resources by underwriting patient satisfaction and financial sustainability.

A 90-Day Episode-of-Care Analysis Including Computed Tomography Scans of Robotic-Arm Assisted versus Manual Total Knee Arthroplasty.

In this observational, retrospective study, we performed economic analyses between robotic arm-assisted total knee arthroplasty (RATKA) and manual total knee arthroplasty (MTKA). Specifically, we compared: (1) index costs including computed tomography (CT) scans; (2) 90-day postoperative health care utilization, (3) 90-day episode-of-care (EOC) costs, and (4) lengths of stay between CT scan-based robotically-assisted versus MTKAs. A large national database, Blue Health Intelligence (BHI), was used for RATKAs and MTKAs performed between April 1, 2017 and September 30, 2019. Based on strict inclusion-exclusion criteria, with propensity score matching, 4,135 RATKAs and 4,135 MTKAs were identified and analyzed. Index costs to the payer for RATKA patients were found to be less than those for MTKA patients ($29,984 vs. $31,280, p <0.0001). Overall, 90-day EOC costs for RATKA patients were found to be less than that for MTKA patients in the inpatient and outpatient settings. This also holds true for the use of skilled nursing facilities, pharmacies, or other services. In conclusion, the results from our study show that RATKA were associated with lower costs than MTKAs, even when including the cost of CT scans. These results are of marked importance given the emphasis to contain and reduce health care costs.

A real-world comparison of the clinical and economic utility of OVA1 and CA125 in assessing ovarian tumor malignancy risk.

Aim: This largest-of-its-kind study evaluated the clinical utility of CA125 and OVA1, commonly used as ovarian tumor markers for assessing the risk of malignancy. The research focused on the ability and utility of these tests to reliably predict patients at low risk for ovarian cancer. Clinical utility endpoints were 12-month maintenance of benign mass status, reduction in gynecologic oncologist referral, avoidable surgical intervention and associated cost savings. Materials & methods: This was a multicenter retrospective review of data from electronic medical records and administrative claims databases. Patients receiving a CA125 or OVA1 test between October 2018 and September 2020 were identified and followed for 12 months using site-specific electronic medical records to assess tumor status and utilization outcomes. Propensity score adjustment was used to control for confounding variables. Payer allowed amounts from Merative MarketScan Research Databases were used to estimate 12-month episode-of-care costs per patient, including surgery and other interventions. Results: Among 290 low-risk OVA1 patients, 99.0% remained benign for 12 months compared with 97.2% of 181 low-risk CA125 patients. The OVA1 cohort exhibited 75% lower odds of surgical intervention in the overall sample of patients (Adjusted OR: 0.251, p ≤ 0.0001), and 63% lower odds of gynecologic oncologist utilization among premenopausal women (Adjusted OR: 0.37, p = 0.0390) versus CA125. OVA1 demonstrated significant savings in surgical interventions ($2486, p ≤ 0.0001) and total episode-of-care costs ($2621, p ≤ 0.0001) versus CA125. Conclusion: This study underscores the utility of a reliably predictive multivariate assay for assessing ovarian cancer risk. For patients assessed at low risk of ovarian tumor malignancy, OVA1 is associated with a significant reduction in avoidable surgeries and substantial cost savings per patient. OVA1 is also associated with a significant reduction in subspecialty referrals for low-risk premenopausal patients.

The relationship between patient satisfaction and inpatient admissions across teaching and nonteaching hospitals.

The need for healthcare executives to better understand the relationship between patient satisfaction and admission volume takes on greater importance in this age of rising patient expectations and declining reimbursement. Management of patient satisfaction has become a critical element in the day-to-day operations of healthcare organizations pursuing high performance. This study is guided by two principal research questions. First, what is the nature of the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions in acute care hospitals? Second, does the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions differ between teaching hospitals and nonteaching hospitals? Although not suggestive of direct causation, the study findings revealed a statistically significant and positive correlation between patient satisfaction and admission volume in teaching hospitals only. In contrast, a nonsignificant, negative correlation was seen between patient satisfaction and admission in nonteaching hospitals. In the combined teaching and nonteaching sample, a statistically significant, negative correlation was found between patient satisfaction scores and admission volume. With financial performance being driven in part by admission volume and with patient satisfaction affecting hospital patronage, the business case for a strategic focus on patient satisfaction in teaching hospitals is clearly evident. The article concludes with a set of recommendations for strengthening patient satisfaction and organizational performance.

Structural relationships between work environment and service quality perceptions as a function of customer contact intensity: implications for human service strategy.

This study assesses the importance of customer-contact intensity at the service encounter level as a determinant of service quality assessments. Using data from the U.S. Department of Veterans Affairs, it shows that performance-driven human resources practices play an important role as determinants of employee customer orientation and service capability in both high-contact (outpatient healthcare) and low-contact (benefits claim processing) human service contexts. However, there existed significant differences across service delivery settings in the salience of customer orientation and the congruence between employee and customer perceptions of service quality, depending on the intensity of customer contact. In both contexts, managerial attention to high-performance work systems and customer-orientation has the potential to favorably impact perceptions of service quality, amplify consumer satisfaction, and enhance operational efficiency.

Use of combinatorial pharmacogenomic guidance in treating psychiatric disorders.

AIM: To evaluate payer costs associated with treating psychiatric disorders utilizing a combinatorial pharmacogenomics test versus treatment-as-usual (TAU). PATIENTS & METHODS: Administrative claims data were analyzed from health plan members whose treatment was guided by GeneSight® Psychotropic testing (CPGx® cohort) and those who received TAU (TAU cohort). Reimbursed costs were calculated over the 12-month pre-index and post-index event periods. RESULTS: 205 CPGx and 478 TAU members were included. Post-index cost savings (US$5505) drove a per-member-per-month savings of US$0.07. Disease-specific analyses resulted in similar savings. CONCLUSION: Use of CPGx yielded reduced spending for a commercial health plan across the patient population with psychiatric disorders, as well as among high-cost subpopulations.

Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector.

Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed.

Economic Impact of Increased Utilization of Multivariate Assay Testing to Guide the Treatment of Ovarian Cancer: Implications for Payers.

BACKGROUND: Ovarian cancer is the eighth most common cancer among women, but ranks fifth in cancer-related causes of death, the majority of which are detected in late stages, after the cancer has metastasized. The CA125 test is the standard of care for assessing suspicious pelvic masses. However, the primary use of CA125 is to monitor treatment progress rather than to screen for disease, and its sensitivity is exceedingly low, unlike the multivariate assay OVA1. A cost-effective treatment of ovarian cancer requires early and accurate diagnosis of pelvic masses and reduced referrals of patients with benign tumors to a gynecologic oncologist. OBJECTIVE: To analyze the economic impact of increased utilization of a multivariate assay, such as OVA1, to guide the treatment of ovarian cancer. METHODS: The study population was drawn from Medicare and commercial health plan claims data. A budget impact model was constructed to estimate the economic consequences of substituting the multivariate assay OVA1 to replace the single biomarker assay CA125 to assess the likelihood of pelvic mass malignancy in premenopausal and/or postmenopausal women. All patients selected for the analysis had CA125 testing before surgical intervention. RESULTS: A total of 92,843 health plan members were included for analysis, comprising 48,113 commercially insured members and 44,730 Medicare beneficiaries. Estimates of future health plan expenditures, which were calculated from base-case assumptions, projected overall savings of $0.05 per-member per-month (PMPM) for commercially insured members and $0.01 PMPM for Medicare beneficiaries as a result of increased utilization of OVA1. Sensitivity analysis revealed potential savings of up to $0.17 PMPM for commercially insured patients and up to $0.05 for Medicare beneficiaries. CONCLUSION: The results of the budget impact model support the use of OVA1 instead of CA125 by indicating that modest cost-savings can be achieved, while reaping the clinical benefits of improved diagnostic accuracy, early disease detection, and reductions in multiple, and possibly unnecessary, referrals to gynecologic oncologists.

Satisfaction with medical care among elderly patients: a review of research findings with implications for management practice and future inquiry.

Research on patient satisfaction has focused predominantly on the mainstream adult population (ages 18-64). Satisfaction in older patients has not been adequately studied. Moreover, a systematic review of the research literature that does exist on this topic has not yet been conducted. The literature search yielded only 17 studies that met the selection criteria established for this review. Key research elements and findings from each of the studies are arrayed in matrix form. The results of the literature review are organized and analyzed in terms of four major categories of variables: background characteristics, predispositional variables, service quality attributes, and contextual factors. Special attention is awarded to identifying the determinants of satisfaction among elderly patients and the ways in which their service quality appraisals may differ in comparison with the general adult population of medical care consumers. Implications for management practice and directions for future research are discussed.

Effects of high-involvement work systems on employee satisfaction and service costs in veterans healthcare.

Two strong imperatives for healthcare managers are reducing costs of service and attracting and retaining highly dedicated and competent patient care and support employees. Is there a trade-off or are there organizational practices that can further both objectives at the same time? High-involvement work systems (HIWS) represent a holistic work design that includes interrelated core features such as involvement, empowerment, development, trust, openness, teamwork, and performance-based rewards. HIWS have been linked to higher productivity, quality, employee and customer satisfaction, and market and financial performance in Fortune 1000 firms. Apparently, few prior studies have looked at the impacts of this holistic design within the healthcare sector. This research found that HIWS were associated with both greater employee satisfaction and lower patient service costs in 146 Veterans Health Administration centers, indicating that such practices pay off in both humanistic and financial terms. This suggests that managers implementing HIWS will incur real expenses that are likely to be more than offset by more satisfied employees, less organizational turmoil, and lower service delivery costs, which, in this study, amounted to over $1.2 million in savings for an average VHA facility.

Cognitive predictors of satisfaction with hospital inpatient service encounters among the elderly: a matter of trust.

Given the burgeoning growth of the elderly population, ensuring the satisfaction of senior consumers of health services is worthy of heightened attention by healthcare administrators both on economic and social grounds. By examining inpatient satisfaction among the elderly, we have focused our attention on an important and understudied segment of health consumers within a dominant service delivery context. Moreover, we have supplemented traditional hospital service satisfaction indicators by including a variety of rarely used psychological variables as cognitive predictors of service assessments. This study reinforces the empirical connection between trust in one's physician and elderly inpatient satisfaction at an increased level. The results suggest that increased levels of trust is positively associated with overall satisfaction of elderly inpatients as well as their satisfaction with several subdimensions of service that represent specific attributes of the hospital inpatient encounter.

Best practices for preempting payment denials.

Limiting inpatient claims denials requires a combination of data, processes, and people, including: Systems that support collecting correct payer data; Creative processes to prevent denials in high-denial areas; Compliance with payer protocols; Enhanced front-end staffing.

Health economics of percutaneous hemodynamic support in the treatment of high-risk cardiac patients: a systematic appraisal of the literature.

This article systematically appraises the findings and conclusions derived from six recent studies of the economic impact and relative value of using percutaneous ventricular assist devices to render short-term hemodynamic support to high-risk patients with particular attention to the settings of cardiogenic shock and percutaneous coronary interventions. Although the extant body of literature is still growing, these studies offer evidence and insight regarding the health economics of traditional and emerging technologies in this treatment domain, and generally find the latter to be cost-effective in the long term. As the incidence of heart disease rises and the attendant economic burden of healthcare climbs, technologies for mitigating cardiovascular illness will be the target for more robust empirical evidence to justify the comparative value of minimally invasive hemodynamic support interventions in the armamentarium of treatment options available to physicians.

Economic and operational implications of a standardized approach to hemodynamic support therapy using percutaneous cardiac assist devices.

OBJECTIVE: Impella 2.5 has been shown to reduce major adverse events for patients undergoing elective high-risk percutaneous coronary intervention. We performed a single-center retrospective study to compare the costs and resource use of Impella 2.5 and intra-aortic balloon pump (IABP) support. METHODS: All high-risk patients who received Impella 2.5 (n = 35) and IABP (n = 295) support from December 2008 to July 2011 were included. Propensity score matching identified a balanced 1:1 matched cohort (35 Impella vs 35 IABP) based on indications for implantation, preimplantation hemodynamics, and age. Diagnostic, procedural, financial, and resource use data were collected. RESULTS: As compared with IABP, Impella offered a more predictable course of treatment/resource consumption and was not associated with any extreme cost outliers (17.1% vs 0.0%, respectively; P = 0.025). The mean admission and 90-day episode of care total costs for Impella were 5.5% ($67,681 vs $71,608, P = 0.79) and 4.2% ($70,680 vs $73,476, P = 0.85) lesser than that for IABP, respectively. Although not statistically significant, Impella patients had a trend toward lower rehospitalization rates (11.4% vs 20%), lesser mean index length of hospital stay (11.2 vs 13.7), and 90-day (11.7 vs 14.2) episode of care length of hospital stay. CONCLUSIONS: Impella support was associated with consistent course of treatment/resource consumption with significantly fewer 90-day extreme cost outliers than was IABP. The lower index and 90-day follow-up cost trends observed for Impella were driven by shorter length of hospital stay and fewer rehospitalizations. As providers strive to improve quality of care by reducing variability, these findings have implications for the development of hemodynamic support algorithms.

A value-based analysis of hemodynamic support strategies for high-risk heart failure patients undergoing a percutaneous coronary intervention.

BACKGROUND: The economic burden of heart disease is heavy and growing. As advanced technologies for treating heart disease become available, decision makers need to be able to assess the relative value of such options against existing standards of care. OBJECTIVES: To compare the clinical and economic benefits of a percutaneous ventricular assist device (pVAD) versus an intra-aortic balloon pump (IABP) observed during the 90-day duration of the PROTECT II clinical trial, and to supplement these findings with a simulation of the longer-term value of this technology through the use of a Markov model to estimate the incremental cost-effectiveness of a pVAD relative to an IABP, in terms of quality-adjusted life-years (QALYs). METHODS: Hospital bills were collected for patients enrolled in the PROTECT II trial who received hemodynamic support for high-risk percutaneous coronary intervention (PCI) provided by a pVAD (Impella 2.5) versus a conventional IABP during a 90-day episode of care (EOC). Length of stay, charges, and costs were analyzed for the index admissions, intensive care unit confinements, readmissions, and overall EOC. In addition, a probabilistic Markov model was used to project these parameters and their impact on a patient's quality of life for up to 10 years in relation to a pVAD versus an IABP. RESULTS: Hospital costs for the index admission were lower for the IABP compared with the pVAD ($33,684 vs $47,667; P <.001), whereas readmission length of stay and costs were lower for the pVAD versus the IABP (5 days vs 7 days; and $11,007 vs $21,834, respectively; P <.001). The total 90-day hospital charges were similar for the pVAD and the IABP ($172,564 vs $172,758, respectively; P = .785); however, the total 90-day EOC cost was lower for the IABP than for the pVAD ($44,032 vs $53,171, respectively; P <.001). The median hospital days for the entire EOC were 7 days for the pVAD versus 9 days for the IABP (P = .008). Critical care stays were considerably shorter for a pVAD than for an IABP on readmissions (3.88 days vs 7.00 days; P = .145). Reduction in major adverse cardiovascular and cerebrovascular events resulted in a projected gain of 0.26 QALYs over 10 years, yielding an incremental cost-effectiveness ratio of $39,389/QALY. CONCLUSIONS: For high-risk patients with advanced heart failure undergoing PCI, the new pVAD reduced major adverse events, critical care and readmission length of stay, and readmission cost over the 90-day EOC, and was determined to be cost-effective over the long-term. These findings can assist decision makers in forming value-based judgments with regard to new hemodynamic support strategies.