{
  "abstract": "BackgroundTemporary mechanical circulatory support (MCS) for acute myocardial infarction complicated by cardiogenic shock (AMI-CS) includes microaxial-flow pumps (mFP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and combined mFP-ECMO support. These strategies differ substantially in haemodynamic capability and resource use, but their short-term cost-effectiveness has not been compared within a common decision framework.\n\nMethodsWe developed a 4-strategy decision-analytic model comparing No MCS (standard care without temporary MCS), mFP, VA-ECMO, and mFP-ECMO from the perspective of a publicly funded Australian health system over 30 days. Costs were estimated from individual resource components in 2025-26 Australian dollars and benchmarked against hospital casemix data. The primary outcome was cost per additional 30-day survivor. Scenario analyses and probabilistic sensitivity analysis assessed parameter uncertainty.\n\nResultsExpected per-patient costs were A$34,562 for No MCS, A$125,269 for mFP, A$133,573 for VA-ECMO, and A$177,481 for mFP-ECMO. Assigned 30-day survival probabilities were 56.1%, 74.2%, 54.3%, and 53.9%, respectively. mFP was the only non-dominated MCS strategy, with an incremental cost-effectiveness ratio of A$502,695 per additional survivor compared with No MCS. Under the assigned cross-cohort inputs, VA-ECMO and mFP-ECMO were more costly and less effective, remained strictly dominated across all prespecified scenarios, and required 30-day survival above 74.2% to escape dominance. Intensive care unit (ICU) bed-days were the largest cost component. At a willingness-to-pay threshold of A$500,000 per additional survivor, the probabilities of being optimal were 44.0% for No MCS, 54.1% for mFP, 1.7% for VA-ECMO, and 0.2% for mFP-ECMO.\n\nConclusionsUnder the assigned cross-cohort inputs, escalation of MCS beyond mFP in AMI-CS increased costs without improving modelled 30-day survival. Nevertheless, VA-ECMO and mFP-ECMO remain essential for selected patients requiring greater circulatory or respiratory support.\n\nWhat Is Known* Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) carries high short-term mortality and substantial healthcare costs. Temporary mechanical circulatory support (MCS) strategies differ markedly in clinical effectiveness, complication profiles, acquisition costs, and critical-care resource use.\n\n* Existing economic evaluations have largely been limited to pairwise comparisons and have not assessed escalation from No MCS to multiple MCS strategies within a single cost-effectiveness framework in a public, government-funded healthcare setting.\n\nWhat the Study Adds* A common cost-effectiveness frontier comparing No MCS with mFP, VA-ECMO, and mFP-ECMO showed that mFP was the only non-dominated MCS strategy, with an incremental cost-effectiveness ratio of A$502,695 per additional 30-day survivor.\n\n* VA-ECMO and mFP-ECMO would each require 30-day survival exceeding 74.2% to avoid economic dominance. VA-ECMO remained dominated even when its device acquisition cost was reduced to zero.\n\n* ICU bed-days, rather than device acquisition alone, were the principal cost driver in every arm, identifying critical-care resource use as the factor with the greatest influence on value.",
  "abstract_shown": true,
  "affiliations": [
    "The Royal Melbourne Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "name": "A. Kamalakkannan"
    },
    {
      "name": "Y. Yang"
    },
    {
      "name": "R. Batchelor"
    },
    {
      "name": "B. Backhouse"
    },
    {
      "name": "K. Munro"
    },
    {
      "name": "F. Groen"
    },
    {
      "name": "F. Yanase"
    },
    {
      "name": "J. Anstey"
    },
    {
      "name": "A. Taylor"
    },
    {
      "name": "J. Dyett"
    },
    {
      "name": "C. French"
    },
    {
      "name": "F. McGain"
    },
    {
      "name": "J. Lefkovits"
    },
    {
      "name": "N. Cox"
    },
    {
      "affs": [
        0
      ],
      "name": "W. Chan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3a12925ex77hr.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.08.26362578",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362578v1.full",
  "id": "3a12925ex77hr",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362578v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ],
    [
      "openalex",
      "2204|Mechanical Circulatory Support Devices"
    ]
  ],
  "openalex": "W7212318425",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362578v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3a12925ex77hr.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "10.64898/2026.09.08.26362578",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362578v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Defining cost-effectiveness of mechanical circulatory support escalation among patients with acute myocardial infarction complicated by cardiogenic shock",
  "title_text": "Defining cost-effectiveness of mechanical circulatory support escalation among patients with acute myocardial infarction complicated by cardiogenic shock",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:18Z",
  "url": "https://research.draconitic.com/paper/3a12925ex77hr",
  "venue": "medRxiv",
  "versions": []
}