Cost-utility of extracorporeal cardiopulmonary resuscitation in patients with cardiac arrest

Resuscitation. 2019 Mar;136:126-130. doi: 10.1016/j.resuscitation.2019.01.027. Epub 2019 Feb 1.

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a resource-intensive tool that provides haemodynamic and respiratory support in patients who have suffered cardiac arrest. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution.

Methods: We performed a retrospective review of patients who received ECPR following cardiac arrest between 2012 and 2018. All medical care-associated charges with ECPR and subsequent hospital admission were recorded. The quality-of-life of survivors was assessed with the Health Utilities Index Mark II. The cost-utility of ECPR was calculated with cost and quality-of-life data.

Results: ECPR was used in 32 patients (15/32 in-hospital, 47%) with a median age of 55.0 years (IQR 46.3-63.3 years), 59% male and 66% African American. The median duration of ECPR support was 2.1 days (IQR 0.9-3.8 days). Survival to hospital discharge was 16%. The median score of the Health Utilities Index Mark II at discharge for the survivors was 0.44 (IQR 0.32-0.52). The median operating cost for patients undergoing ECMO was $125,683 per patient (IQR $49,751-$206,341 per patient). The calculated cost-utility for ECPR was $56,156/QALY gained.

Conclusions: The calculated cost-utility is within the threshold considered cost-effective in the United States (<$150,000/QALY gained). These results are comparable to the cost-effectiveness of heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics, affect the cost-utility benefit.

Keywords: Advanced cardiac life support; Cardiac arrest; Cost; Cost-utility; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation.

MeSH terms

  • Adult
  • Aged
  • Cardiopulmonary Resuscitation / methods*
  • Cost-Benefit Analysis
  • Extracorporeal Membrane Oxygenation / economics*
  • Extracorporeal Membrane Oxygenation / mortality
  • Female
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / economics
  • Out-of-Hospital Cardiac Arrest / mortality
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Quality-Adjusted Life Years
  • Registries
  • Retrospective Studies