{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:12:36Z","timestamp":1789517556066,"version":"build-2803163510"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":45,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a calibrated partitioned-survival model comparing ECPELLA with GDMT over a 10-year horizon from a statutory health insurance payer perspective (2024\u20ac 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<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ECPELLA yielded 4.05 quality-adjusted life-years (QALYs) at \u20ac195 000 vs. 3.10 QALYs at \u20ac95 000 for GDMT (incremental cost \u20ac100 000; incremental QALY 0.95), resulting in an incremental cost-effectiveness ratio (ICER) of \u20ac105 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 \u20ac60 000\u201380 000 per QALY), whereas neutral survival effects produced ICERs exceeding \u20ac300 000 per QALY. Value-of-information analysis indicated residual decision uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ECPELLA increased quality-adjusted survival at higher cost. In the base-case analysis, the ICER was \u20ac105 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeag064","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:40:24Z","timestamp":1775821224000},"source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of combined veno-arterial extracorporeal membrane oxygenation and Impella support (ECPELLA) in infarct-related cardiogenic shock"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0534-132X","authenticated-orcid":false,"given":"Priyanka","family":"Boettger","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine, Justus-Liebig-University , Klinikstrasse 33, 35392 Giessen, Hessen ,","place":["Germany"]},{"name":"Department of Health Policy, London School of Economics and Political Science , London ,","place":["UK"]},{"name":"Cardio-Pulmonary Institute (CPI) , 35392 Giessen, Hessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9272-6906","authenticated-orcid":false,"given":"Andrija","family":"Matetic","sequence":"additional","affiliation":[{"name":"Department of Health Policy, London School of Economics and Political Science , London ,","place":["UK"]},{"name":"Department of Cardiology, University Hospital Split , 21000 Split ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9107-8063","authenticated-orcid":false,"given":"Jamschid","family":"Sedighi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine, Justus-Liebig-University , Klinikstrasse 33, 35392 Giessen, Hessen ,","place":["Germany"]},{"name":"Cardio-Pulmonary Institute (CPI) , 35392 Giessen, Hessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Unsoeld","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine, Justus-Liebig-University , Klinikstrasse 33, 35392 Giessen, Hessen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Struenck","sequence":"additional","affiliation":[{"name":"Department of Social Sciences, Faculty of Humanities, University of Siegen , 57076 Siegen, North Rhine-Westphalia ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buerke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Heart-Center-S\u00fcdwestfalen, Cardiology, Angiology and Intensive Care Medicine, St.Marien-Krankenhaus , 57072 Siegen, North Rhine-Westphalia ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg , Baden-W\u00fcrttemberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Sossalla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Cardiology, Angiology and Intensive Care Medicine, Justus-Liebig-University , Klinikstrasse 33, 35392 Giessen, Hessen ,","place":["Germany"]},{"name":"Cardio-Pulmonary Institute (CPI) , 35392 Giessen, Hessen ,","place":["Germany"]},{"name":"Department of Cardiology, Kerckhoff Clinic, Campus Kerckhoff of the Justus-Liebig-University Giessen , 61231 Bad Nauheim, Hessen 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