Ekonomika a management
COST-EFFECTIVENESS OF EXTRACORPOREAL MEMBRANE OXYGENATION IN RESUSCITATION OF PATIENTS WITH REFRACTORY CARDIAC ARREST
Health care economists estimate that 40-50% of annual cost increases can be traced to new technologies or the intensified use of old ones (Callahan, 2008). However, any limitation of their application is massively criticized as unethical. Patients (supported by journalists) believe that new expensive technology will speed-up their treatment and miraculously enhance their quality of life, while physicians are fascinated by fanciful possibilities of state-of-the-art devices. Nevertheless, due to limited resources of health care, each particular utilization of a medical device should be put to the test of the clinical effectiveness and cost-effectiveness (Markiewicz, van Til, & Ijzerman, 2014; Rosina et al., 2014). The typical approach used above all in drugs is to calculate cost-effectiveness when the technology is in routine use.
Jméno a příjmení autora:
Klára Burišková, Vladimír Rogalewicz, Petr Ošťádal
Cost-effectiveness, cost-utility, extracorporeal cardiopulmonary resuscitation, ECPR, refractory cardiac arrest
DOI (& full text):
Extracorporeal cardiopulmonary resuscitation (ECPR) has been recently introduced as a therapeutic option for refractory cardiac arrest. Despite growing evidence demonstrating improved survival rate,…více
Extracorporeal cardiopulmonary resuscitation (ECPR) has been recently introduced as a therapeutic option for refractory cardiac arrest. Despite growing evidence demonstrating improved survival rate, a number of questions remains unanswered and data on cost-effectiveness are still insufficient. The paper is based on a retrospective observational comparative study of authentic clinical data from patient records. Incremental cost-effectiveness and cost-utility analyses were performed from health care provider’s perspective. Sixteen patients undergoing ECPR were included into the analysis and their data were compared with 35 subjects with conventional CPR for refraktory cardiac arrest. In the ECPR group eight out of sixteen patients were weaned from ECMO, four of them with good neurological outcomes (CPC 1-2); three patients survived one year with CPC 1-2, one patient survived one year with severe neurological dysfunction (CPC 3), and one patient with persisting coma (CPC 4). In comparison, in the non-ECPR group all patients died within 24 hours. In the ECPR group, the average annual costs per patient reached CZK 885,044 (Levitronix Centrimag), and CZK 788,432 (Cardiohelp) (the 2013 price level). CUA revealed 3,961,970 CZK/QALY with Cardiohelp, and 4,447,457 CZK/QALY with Levitronix. However, if only patients with CPC 1-2 were included into the analysis, the cost-utility ratio decreased below the unofficial Czech cost-effectiveness threshold. Our data indicate that ECPR for refractory cardiac arrest may be cost-effective despite high costs per individual patients, especially if we were able to better select patients for this intervention based on a reliable prediction of the neurological outcome.
Ekonomika a management