title: Venoarterial extracorporeal membrane oxygenation for patients in shock or cardiac arrest secondary to cardiotoxicant poisoning: a cost-effectiveness analysis.
abstract: OBJECTIVE
  Venoarterial extracorporeal membrane oxygenation represents an emerging and recommended option to treat life-threatening cardiotoxicant poisoning. The objective of this cost-effectiveness analysis was to estimate the incremental cost-effectiveness ratio of using venoarterial extracorporeal membrane oxygenation for adults in cardiotoxicant-induced shock or cardiac arrest compared with standard care.
  
  
  METHODS
  Adults in shock or in cardiac arrest secondary to cardiotoxicant poisoning were studied with a lifetime horizon and a societal perspective. Venoarterial extracorporeal membrane oxygenation cost effectiveness was calculated using a decision analysis tree, with the effect of the intervention and the probabilities used in the model taken from an observational study representing the highest level of evidence available. The costs (2013 Canadian dollars, where $1.00 Canadian = $0.9562 US dollars) were documented with interviews, reviews of official provincial documents, or published articles. A series of one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were used to evaluate uncertainty in the decision model.
  
  
  RESULTS
  The cost per life year (LY) gained in the extracorporeal membrane oxygenation group was $145 931/18 LY compared with $88 450/10 LY in the non-extracorporeal membrane oxygenation group. The incremental cost-effectiveness ratio ($7185/LY but $34 311/LY using a more pessimistic approach) was mainly influenced by the probability of survival. The probabilistic sensitivity analysis identified variability in both cost and effectiveness.
  
  
  CONCLUSIONS
  Venoarterial extracorporeal membrane oxygenation may be cost effective in treating cardiotoxicant poisonings.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Ontario Poison Centre, Toronto, Ontario, Canada. Electronic address: egnomie@hotmail.com.
authors.forename: Maude
authors.initials: M
authors.lastname: St-Onge
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: eddy.fan@uhn.ca.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM U1144, Paris-Diderot University, Paris, France. Electronic address: bruno.megarbane@lrb.aphp.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mégarbane
authors.affiliation: Health System Strategy and Policy Division, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada. Electronic address: rebecca.hancock-howard@ontario.ca.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hancock-Howard
authors.affiliation: University of Toronto, Toronto, Ontario, Canada; Health Economics at the Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada. Electronic address: peterccoyte@gmail.com.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D054715:Cardiotoxins / Q000506:poisoning*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006323:Heart Arrest / Q000139:chemically induced / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D054715:Cardiotoxins
keywords: Cardiotoxins; Cost analysis; Extracorporeal circulation; Extracorporeal membrane oxygenation; Overdose; Poisoning