Cost-utility of venoarterial extracorporeal membrane oxygenation in cardiogenic shock and cardiac arrest

Abstract

Background: The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown. Methods: We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013–2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients’ health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%. Results: The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€). Conclusions: We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.

Hospital Costs of Extracorporeal Membrane Oxygenation in Adults: A Systematic Review

“…The study by Kawashima et al reported on costs according to first documented rhythm in ECPR patients [ 11 ], with median costs of US$22,305 in asystole/pulseless electrical activity (PEA) patients and US$30,553 in patients presenting with ventricle tachycardia/ventricle fibrillation (VT/VF). The study by Jäämaa-Holmberg et al provided a median cost of US$187,282 [ 13 ], and for the non-US studies, the costs ranged between a mean of US$851 and US$4615. Jäämaa-Holmberg provided a median cost of US$5852 per day in hospital [ 13 ].…”

“…The study by Jäämaa-Holmberg et al provided a median cost of US$187,282 [ 13 ], and for the non-US studies, the costs ranged between a mean of US$851 and US$4615. Jäämaa-Holmberg provided a median cost of US$5852 per day in hospital [ 13 ].…”

“…The mean cost for ECPR was US$81,715. Four studies reported on patients receiving ECMO post-cardiotomy [ 13 , 23 – 25 ], with a mean cost of US$101,043, and four studies reported on patients receiving respiratory ECMO (no ECCO 2 R) [ 4 , 23 – 25 ], with a mean cost of US$132,496. Two studies reported on patients receiving ECMO after lung transplant [ 21 , 25 ], with a mean cost of US$328,588.…”

“…Two studies reported on patients receiving ECMO after lung transplant [ 21 , 25 ], with a mean cost of US$328,588. In a study of patients in cardiogenic shock or cardiac arrest, the costs were reported according to the etiology [ 13 ]. The median hospital costs were US$292,100 for post heart transplant, US$187,357 for cardiomyopathy, US$184,376 for myocarditis, US$143,729 post-cardiotomy, and US$63,451 for acute coronary syndrome.…”

“… Costs are expressed as means, except Jäämaa-Holmberg [ 13 ], Chung [ 20 ] and Hayanga [ 21 ], which are expressed as median costs ECPR extracorporeal cardiopulmonary resuscitation, US$ United States dollar …”