Cost Utility Evaluation of Extracorporeal Membrane Oxygenation as a Bridge to Transplant for Children With End-Stage Heart Failure due to Dilated Cardiomyopathy
| Autor: | Katherine L Brown, Michael Burch, Jo Wray, Tracey Lunnon Wood, John Cairns, Anne Marie Mc Mahon |
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| Rok vydání: | 2009 |
| Předmět: |
Cardiomyopathy
Dilated Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Critical Care Cost effectiveness Cost-Benefit Analysis Health Status medicine.medical_treatment Extracorporeal Membrane Oxygenation Life Expectancy Intensive care Extracorporeal membrane oxygenation Humans Medicine Child Intensive care medicine Retrospective Studies Heart Failure Transplantation business.industry Patient Selection Hazard ratio Arrhythmias Cardiac Dilated cardiomyopathy medicine.disease Survival Analysis Markov Chains United Kingdom Heart Arrest Quality-adjusted life year surgical procedures operative Child Preschool Cohort Costs and Cost Analysis Quality of Life Heart Transplantation Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Heart and Lung Transplantation. 28:32-38 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2008.10.006 |
| Popis: | Background Extracorporeal membrane oxygenation (ECMO) and cardiac transplantation are recognized to be expensive. Methods We performed a cost utility evaluation with a decision model approach, including 75 children with dilated cardiomyopathy. A cohort of patients with end stage heart failure who were offered ECMO bridging was compared with a similar cohort offered only conventional intensive care. Outcome was measured in cost per quality adjusted life year (QALY). Results Median follow-up was 4.39 years (interquartile range, 1.83–5.74 years), during which 50 children underwent transplantation, 16 had a period of recovery, and 25 died. ECMO bridging was highly effective (hazard ratio, 0.181; 95% confidence interval, 0.067–0.489; p = 0.001) but exceeded conventional criteria for cost-effectiveness. The reference incremental cost-effectiveness ratio (ICER) was £65,645 per QALY and £54,284 per life-year gained. Average life expectancy rose from 6.78 to 9.79 years and costs from £146,398 to £309,599 per patient with ECMO bridging. The ICER was sensitive to ECMO cost, the long-term transplant survival rate, and quality of life in transplant recipients. Conclusions ECMO bridging is effective but expensive. The eligible target population is small, nationally, positively influencing affordability. We strongly support our national policy of mechanical bridge to transplant for suitable children in end stage heart failure. Cost effectiveness could be optimized by: 1) increased availability of organ donors, 2) reduction in mechanical support costs possibly by alternate devices and 3) inclusion of patients most likely to benefit. |
| Databáze: | OpenAIRE |
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