Abstract 16203: A Case for Cardiomems Use in Cardiac Amyloidosis to Prevent Hospitalization

Le résumé fourni par la source

Background: Patients with cardiac amyloidosis (CA) have recurrent hospital admissions for heart failure (CHF). However, CardioMEMS placement is still considered ‘investigational’ by various insurance payers, requiring peer-to-peer review for approval. Landmark CardioMEMS trials did not identify CA patients in their cohort, so the benefit is unclear. Results and Discussion: Three patients with symptomatic CA (2 with light-chain, one with transthyretin CA) are presented. All the patients had chronic kidney disease stage 3, worsening orthostatic symptoms with heart failure medical therapy and a history of ≥ 2 hospitalizations/year for CHF with acute kidney injury. To prevent further hospitalizations, CardioMEMS was planned but denied by their respective insurance companies as ‘investigational use’, which required a rigorous appeal process to overturn. One year prior to CardioMEMS, there were 8 hospitalizations due to CHF between all three candidates. After implantation, there was only 1 CHF-related hospitalization. This represents a 88% decrease in hospital admissions for CHF, saving a potential 7 CHF hospitalizations in the succeeding year and potentially adding one quality-adjusted life-year (QALY)/patient. Decompensated CHF adversely affects the quality of life of CA patients. CardioMEMs costs $20,000/device on average and $100/month of monitoring cost. The average cost of heart failure hospitalization is $14,000. Amongst the 3 patients, there was a total expenditure of $112,000 in hospitalizations prior to CardioMEMS placement. With an 88% reduction in hospitalization and correcting for the cost of device placement and monitoring, there was a $11,653/patient/year decrease in spending with CardioMEMS placement. Additionally, the cost of adding 1 QALY/patient was only $21,200 with CardioMEMS. The Institute for Clinical and Economic Review values one QALY at $50,000 to $150,000 as an acceptable cost and the expenditure with CardioMEMS comes significantly lower. Conclusion: CardioMEMs has been shown to decrease the number of hospitalizations in patients with HF and has a similar benefit in patients with CA. The CardioMEMs device has the capability to improve patient quality of life and decrease the cost of medical care of CA patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.