Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study
| Autor: | Yosuke Yamamoto, Yoshinori Matsuoka, Tetsuya Sakamoto, Hiroyuki Yokota, Ken Nagao, Rei Goto, Koichi Ariyoshi, Naoto Morimura, Takahiro Atsumi, Yasufumi Asai, Yoshio Tahara |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis 030204 cardiovascular system & hematology Emergency Nursing 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation Modified Rankin Scale medicine Humans Extracorporeal cardiopulmonary resuscitation Cardiopulmonary resuscitation Prospective Studies Prospective cohort study business.industry 030208 emergency & critical care medicine medicine.disease Cardiopulmonary Resuscitation Advanced life support Emergency medicine Ventricular fibrillation Emergency Medicine Observational study Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 157 |
| ISSN: | 1873-1570 |
| Popis: | Aim Extracorporeal cardiopulmonary resuscitation (ECPR) is an evolving resuscitative method for refractory cardiopulmonary arrests. However, considering the substantial healthcare costs and resources involved, there is an urgent need for a full economic evaluation. We therefore assessed the cost-effectiveness of ECPR for refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). Methods We developed a decision model to estimate lifetime costs and outcomes for out-of-hospital cardiac arrest patients with VF/pVT who received either ECPR or conventional cardiopulmonary resuscitation. Quality-adjusted life-years (QALY) was used as the main outcome measure. This model was a combination of a decision tree model for the acute phase based on a prospective observational study (SAVE-J study), together with a Markov model for long-term follow-up periods extrapolated from published data. To evaluate the robustness of this model, we conducted a comprehensive deterministic sensitivity analysis (DSA) and a probabilistic sensitivity analysis (PSA). Results ECPR was cost-effective, with an incremental cost of ¥3,521,189 (Є30,227), an incremental effectiveness of 1.34 QALY, and an incremental cost-effectiveness ratio of ¥2,619,692 (Є22,489) per QALY gained. DSA revealed that the present model was most sensitive to probability of Cerebral Performance Category 1 after ECPR (¥2,153,977/QALY to ¥3,186,475/QALY), patient age (¥2,170,112/QALY to ¥3,334,252/QALY), and long-term medical cost for modified Rankin Scale 0 (¥2,280,352/QALY to ¥2,855,330/QALY). PSA indicated ECPR to be cost-effective and below the willingness-to-pay threshold of ¥5,000,000 with an 86.7 % possibility. Conclusions ECPR was an economically acceptable resuscitative strategy, and the results of the present study were robust even when considering the uncertainty of all parameters. |
| Databáze: | OpenAIRE |
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