Cost-effectiveness of extracorporeal cardiopulmonary resuscitation vs. conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a pre-planned, trial-based economic evaluation.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-06-30 DOI:10.1093/ehjacc/zuae050
Thijs S R Delnoij, Martje M Suverein, Brigitte A B Essers, Renicus C Hermanides, Luuk Otterspoor, Carlos V Elzo Kraemer, Alexander P J Vlaar, Joris J van der Heijden, Erik Scholten, Corstiaan den Uil, Sakir Akin, Jesse de Metz, Iwan C C van der Horst, Jos G Maessen, Roberto Lorusso, Marcel C G van de Poll
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Abstract

Aims: When out-of-hospital cardiac arrest (OHCA) becomes refractory, extracorporeal cardiopulmonary resuscitation (ECPR) is a potential option to restore circulation and improve the patient's outcome. However, ECPR requires specific materials and highly skilled personnel, and it is unclear whether increased survival and health-related quality of life (HRQOL) justify these costs.

Methods and results: This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands. We analysed healthcare costs in the first year and measured HRQOL using the EQ-5D-5L at 1, 3, 6, and 12 months. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes, and acceptability curves were calculated. Sensitivity analyses were performed for per-protocol and as-treated subgroups as well as imputed productivity loss in deceased patients. In total, 132 patients were enrolled: 62 in the CCPR and 70 in the ECPR group. The difference in mean costs after 1 year was €5109 (95% confidence interval -7264 to 15 764). Mean quality-adjusted life year (QALY) after 1 year was 0.15 in the ECPR group and 0.11 in the CCPR group, resulting in an ICER of €121 643 per additional QALY gained. The acceptability curve shows that at a willingness-to-pay threshold of €80.000, the probability of ECPR being cost-effective compared with CCPR is 36%. Sensitivity analysis showed increasing ICER in the per-protocol and as-treated groups and lower probabilities of acceptance.

Conclusion: Hospital-based ECPR in refractory OHCA has a low probability of being cost-effective in a trial-based economic evaluation.

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OHCA 中 ECPR 与 CCPR 的成本效益;一项预先计划、基于试验的经济评估。
导言:当院外心脏骤停(OHCA)成为难治性疾病时,体外心肺复苏(ECPR)是恢复循环和改善患者预后的潜在选择。然而,体外心肺复苏需要特殊材料和高技能人员,目前还不清楚提高存活率和健康相关生活质量(HRQOL)是否能证明这些成本是合理的:这项成本效益研究是 INCEPTION 研究的一部分,INCEPTION 研究是一项多中心、务实的随机试验,在荷兰的 10 个心脏外科中心对难治性 OHCA 患者进行医院 ECPR 与传统 CPR(CCPR)的比较。我们分析了第一年的医疗成本,并使用 EQ-5D-5L 测量了 1、3、6 和 12 个月的 HRQOL。计算了增量成本效益比 (ICER)、成本效益平面和可接受性曲线。对按方案分组和按治疗分组以及已故患者的生产力损失进行了敏感性分析:共有 132 名患者入组:CCPR组62人,ECPR组70人。一年后的平均费用差异为 5,109 欧元(95%CI -7,264-15,764)。ECPR 组一年后的平均 QALY 为 0.15,CCPR 组为 0.11,因此每增加一个 QALY 的 ICER 为 121,643 欧元。可接受性曲线显示,当支付意愿阈值为 80,000 欧元时,ECPR 与 CCPR 相比具有成本效益的概率为 36%。敏感性分析表明,按方案组和按治疗组的 ICER 越高,接受概率越低:结论:在基于试验的经济评估中,难治性 OHCA 的医院 ECPR 具有成本效益的概率较低。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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