title: The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis.
abstract: OBJECTIVE
  To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.
  
  
  METHODS
  A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.
  
  
  RESULTS
  The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100 mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Pedro Vitale
authors.initials: PV
authors.lastname: Mendes
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Fernando Godinho
authors.initials: FG
authors.lastname: Zampieri
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luciano Cesar Pontes
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: Unidade de Terapia Intensiva, Hospital Sírio Libanês, São Paulo, SP, Brasil.
authors.forename: Eduardo Leite Vieira
authors.initials: EL
authors.lastname: Costa
authors.affiliation: Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Antoniali
authors.affiliation: Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil.
authors.forename: Gustavo Calado de Aguiar
authors.initials: GC
authors.lastname: Ribeiro
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Caneo
authors.affiliation: Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luiz Monteiro
authors.initials: LM
authors.lastname: da Cruz Neto
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Carlos Roberto Ribeiro
authors.initials: CR
authors.lastname: Carvalho
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Evelinda Marramon
authors.initials: EM
authors.lastname: Trindade
mesh_terms: D000328:Adult; D001938:Brazil; D016208:Databases, Factual; D003663:Decision Trees; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics / Q000379:methods*; D006801:Humans; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D019057:Quality-Adjusted Life Years; D012128:Respiratory Distress Syndrome / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D010100:Oxygen