DOI: 10.1161/circ.148.suppl_1.17955 ISSN: 0009-7322

Abstract 17955: Cost-Effectiveness of a Shock Team Approach in Refractory Cardiogenic Shock

Joseph Taleb, Theodoros Giannouchos, Christos Kyriakopoulos, Antoine Clawson, Erin Davis, Konstantinos Sideris, Kevin S Shah, Joseph Tonna, Elizabeth Dranow, Tara Jones, Spencer Carter, James C Fang, Josef Stehlik, Robert Ohsfeldt, Craig Selzman, Thomas Hanff, Stavros G Drakos
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Multidisciplinary Shock Teams have improved clinical outcomes for cardiogenic shock (CS), but their implementation costs have not been studied.

Objectives: To compare costs between patients treated with and without a Shock Team and determine if the team's implementation is cost-effective compared to standard of care (SoC).

Methods: We examined patients with refractory CS, treated with or without a Shock Team at a tertiary academic hospital from 2009-2018. Real-world hospital data was used to compare costs and outcomes, including survival at discharge, 1-year survival, and quality adjusted life years (QALYs) gained at 1 year. Incremental cost-effectiveness ratios (ICER) were calculated over a 1-year time horizon, with parameter uncertainty evaluated through probabilistic sensitivity analysis using (PSA) 1000 second-order Monte Carlo simulations.

Results: The study involved 244 patients, with 123 treated by the Shock Team and 121 receiving SoC. Patients were predominantly male (77.5%), with a mean age of 58 years (18-92). The Shock Team approach improved survival rates at hospital discharge and 1-year follow-up (61.0% vs 47.9%; p=0.04 & 55.0% vs 40.5%; p=0.03, respectively). The ICER for increases in survival probability at discharge for the multidisciplinary Shock Team compared to SoC was $102,088. The ICER for increases in survival probability at 1-year was estimated at $96,152 and at $127,862 per one QALY gained. PSA estimates showed that the Shock Team was cost-effective in the majority of simulations using a willingness-to-pay threshold of $150,000, while it was also dominant in almost one-third of the simulations.

Conclusion: The Shock Team approach for treating refractory CS may be a cost-effective alternative to traditional SoC. These findings can help prioritize the implementation of Shock Team initiatives to further improve cardiogenic shock outcomes.

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