1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

We are interested in the efficacy of the impella ventricular assist device when used for protected PCI. Use potentially increases the cost of a pci by 50-80k. (It changes the drg to a ventricular assist drg).

2. Why are you struggling with this issue?

Rhe device is new and it is not clear if effective/cost effective at this point. The company, abiomed, is pushing greater use. CMS through fee for service Medicare and Medicare advantage plans will potentially pay for a device without proven efficacy for this indication or deny a device that offers a solution for a frail cohort of elderly patients

3. What do you want to see changed?

How will you know that your issue is improving or has been addressed? Clear recent data will be helpful. The Ontario review is a few years old and the new indication for protected pci is blossoming

4. When do you need the evidence report?

Thu, 10/31/2019

5. What will you do with the evidence report?

Practice guidelines and coverage decisions.