Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children.
BACKGROUND
Indications for extracorporeal membrane oxygenation therapy have expanded to include cardiopulmonary arrest and support after congenital heart surgery. Data from a national registry have reported that cardiac patients have the poorest survival of all extracorporeal membrane oxygenation recipients. Concerns have been raised about the appropriateness of such an aggressive strategy, especially in light of the high costs and potential for long-term neurologic disability. We reviewed our experience with salvage cardiac extracorporeal membrane oxygenation to determine the cost-utility, which accounts for both costs and quality of life.


METHODS
Medical records of patients with congenital heart disease receiving salvage cardiac extracorporeal membrane oxygenation between January 2000 and May 2004 were reviewed. Charges for all medical care after the institution of extracorporeal membrane oxygenation were determined and converted to costs by published standards. The quality-of-life status of survivors was determined with the Health Utilities Index Mark II.


RESULTS
Salvage cardiac extracorporeal membrane oxygenation was instituted in 32 patients (18 for cardiopulmonary arrest and 14 for cardiac failure after heart surgery) at a median age of 2.0 months (range, 4 days to 5.1 years). Congenital heart disease was present in 27 (84%). The mean duration of extracorporeal membrane oxygenation support was 5.1 +/- 4.1 days. Survival to hospital discharge was 50%, including 1 patient bridged to heart transplantation. Survival to 1 year was 47%. The mean score of the Health Utilities Index for the survivors was 0.75 +/- 0.19 (range, 0.41-1.0). The median cost for hospital stay after the institution of extracorporeal membrane oxygenation was USD 156,324 per patient. The calculated cost-utility for salvage extracorporeal membrane oxygenation in this population was USD 24,386 per quality-adjusted life-year saved, which would be considered within the range of accepted cost-efficacy (< USD 50,000 per quality-adjusted life-year saved).


CONCLUSIONS
Salvage cardiac extracorporeal membrane oxygenation results in reasonable survival and is justified on a cost-utility basis.
Mahle
William T
WT
Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine, 52 Executive Park S., Suite 523, Atlanta, GA 30329, USA. mahlew@kidsheart.com
Forbess
Joseph M
JM
Kirshbom
Paul M
PM
Cuadrado
Angel R
AR
Simsic
Janet M
JM
Kanter
Kirk R
KR
D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality / Q000523:psychology; D005845:Georgia / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000191:economics / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D016027:Heart Transplantation; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000191:economics; D008017:Life Expectancy; D018579:Patient Selection; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012042:Registries; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality / Q000523:psychology; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists