Hospital Costs of Extracorporeal Membrane Oxygenation in Adults: A Systematic Review
on behalf of the Dutch Extracorporeal Life Support Study Group
(2021) PharmacoEconomics - open, volume 5, issue 4, pp. 613 - 623
(Article)
Abstract
Background: Costs associated with extracorporeal membrane oxygenation (ECMO) are an important factor in establishing cost effectiveness. In this systematic review, we aimed to determine the total hospital costs of ECMO for adults. Methods: The literature was retrieved from the PubMed/MEDLINE, EMBASE, and Web of Science databases from inception to 4
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March 2020 using the search terms ‘extracorporeal membrane oxygenation’ combined with ‘costs’; similar terms or phrases were then added to the search, i.e. ‘Extracorporeal Life Support’ or ‘ECMO’ or ‘ECLS’ combined with ‘costs’. We included any type of study (e.g. randomized trial or observational cohort) evaluating hospital costs of ECMO in adults (age ≥18 years). Results: A total of 1768 unique articles were retrieved during our search. We assessed 74 full-text articles for eligibility, of which 14 articles were selected for inclusion in this review; six papers were from the US, five were from Europe, and one each from Japan, Australia, and Taiwan. The sample sizes ranged from 16 to 18,684 patients. One paper exclusively used prospective cost data collection, while all other papers used retrospective data collection. Five papers reported charges instead of costs. There was large variation in hospital costs, ranging from US$22,305 to US$334,608 (2019 values), largely depending on the indication for ECMO support and location. The highest reported costs were for lung transplant recipients who were receiving ECMO support in the US, and the lowest reported costs were for extracorporeal cardiopulmonary resuscitation patients presenting with non-shockable rhythm in Japan. The additional costs of ECMO patients compared with non-ECMO patients varied between US$2518 and US$200,658. Personnel costs varied between 11 and 52% of the total amount. Conclusions: ECMO therapy is an advanced and expensive technology, although reported costs differ considerably depending on ECMO indication and whether charges or costs are measured. Combined with the ongoing gathering of outcome data, cost effectiveness per ECMO indication could be determined in the future.
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Keywords: Pharmacology, Health Policy, Pharmacology (medical)
ISSN: 2509-4262
Publisher: Springer Nature Switzerland AG
Note: Funding Information: Members of the Dutch Extracorporeal Life Support Study Group: Annemieke Oude Lansink-Hartgring, Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Walter M. van den Bergh, Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Karin M. Vermeulen, Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Dinis dos Reis Miranda, Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. Thijs S.R. Delnoij, Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. Carlos V. Elzo Kraemer, Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands. Jacinta J. Maas, Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands. Alexander P.J. Vlaar, Department of Intensive Care, Amsterdam University Medical Centers, location Academic Medical Centers, Amsterdam, The Netherlands. Dirk W. Donker, Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands. Erik Scholten, Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands. Anja Balzereit, Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. Judith van den Brule, Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Marijn Kuijpers, Department of Intensive Care, Isala Klinieken, Zwolle, The Netherlands. Funding Information: This project was made possible by a research grant from ZonMw, received by WvdB. Publisher Copyright: © 2021, The Author(s).
(Peer reviewed)