ECONOMIC-IMPLICATIONS OF THE PROPHYLACTIC USE OF INTRAAORTIC BALLOON COUNTERPULSATION IN THE SETTING OF ACUTE MYOCARDIAL-INFARCTION

Intraaortic balloon counterpulsation (IABP) has been shown to improve coronary artery potency and reduce the rates of recurrent myocardial i schemia and its sequelae in selected patients when used within 24 hour s of acute myocardial infarction. The economic implications of prophyl actic IABP use are unknown. We obtained hospital bills for 102 patient s enrolled in the Randomized IABP Trial (56%) and converted charges to costs using each hospital's Medicare cost report. In-hospital costs f or patients who had 48 hours of IABP were compared with those of patie nts who did not. The costs of angiographic and clinical complications were determined. Small differences in clinical and angiographic charac teristics existed between patients in the economic substudy and the ov erall population, but overall angiographic and clinical outcomes were comparable. Costs for patients who had IABP versus control patients we re similar: mean $22,357 +/- $14,369 versus $19,211 +/- $8,414, median (25th and 75th percentiles) $17,903 ($15,787, $22,147) versus $17,913 ($15,144, $21,433), p = 0.45. Hospital costs were higher with the dev elopment of recurrent ischemia: mean $23,125 +/- $7,690 versus $20,416 +/- $12,449, median $21,069 ($17,896, $26,885) versus $17,492 ($14,89 2, $20,498) p = 0.02. Patients who had an adverse clinical event (deat h, stroke, reinfarction, and emergency revascularization) also had hig her hospital costs: mean $25,598 +/- $10,024 versus $19,790 +/- $12,04 5, median $21,877 ($18,380, $28,049) versus $17,364 ($14,773, $20,779) , p = 0.002. The prophylactic use of IABP in patients at high risk of infarct artery reocclusion within 24 hours of acute myocardial infarct ion provides sustained clinical benefit without substantially increasi ng hospital costs. (C) 1997 by Excerpta Medica, Inc.