title: The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis.
abstract: BACKGROUND
  To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV).
  
  
  METHODS
  Retrospective ancillary cost analysis of data extracted from a recently published multicentre case-control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system.
  
  
  RESULTS
  In the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01).
  
  
  CONCLUSIONS
  Additional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. sbraune@uke.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Braune
authors.affiliation: , Bovenden, Germany. hburcha@gwdg.de.
authors.forename: Hilmar
authors.initials: H
authors.lastname: Burchardi
authors.affiliation: Department of Cardiology and Intensive Care, Klinikum Bogenhausen, Munich, Germany. markus.engel@klinikum-muenchen.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Engel
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. nierhaus@uke.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Nierhaus
authors.affiliation: Department of Medicine III, University of Halle (Saale), Halle, Germany. henningebelt@googlemail.com.
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. m.metschke@uke.de.
authors.forename: Maria
authors.initials: M
authors.lastname: Metschke
authors.affiliation: Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany. simone.rosseau@charite.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Rosseau
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. skluge@uke.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism*; D016022:Case-Control Studies; D005112:Extracorporeal Circulation / Q000191:economics / Q000379:methods*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D006935:Hypercapnia / Q000191:economics / Q000628:therapy*; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D063087:Noninvasive Ventilation / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000628:therapy; D012131:Respiratory Insufficiency / Q000191:economics / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide