Risk Stratification and Cost-Effectiveness Analysis of Adult Patients Receiving Extracorporeal Membrane Oxygenation

This article was originally published here

J Eval Clin Pract. 2022 April 1. doi: 10.1111/jep.13681. Online ahead of print.

ABSTRACT

RATIONALE, GOALS AND OBJECTIVES: More efficient allocation of critical care resources is important as the cost of critical care increases. A model was developed to predict the probability of in-hospital death in patients who received extracorporeal membrane oxygenation (ECMO). Cost-effectiveness analyzes (CEAs) were performed regarding the relationship between hospitalization expenditures and predicted survival outcomes.

METHODS: Adult patients who received ECMO at a medical center in Taiwan (2005-2016) were included. A logistic regression model was applied to a range of clinical measures obtained before and during ECMO institutions to identify in-hospital mortality risk variables. ACEs were reported as a predictive risk in quintiles and defined as the cost of each quality-adjusted life year (QALY). The cost-effectiveness ratio (CER) distribution was measured by the ellipse and acceptability curve methods.

RESULTS: A total of 919 patients (659 men, mean age: 53.7 years) were enrolled. Ten variables emerged as significant predictors of in-hospital death. The area under the receiver operating characteristic curve was 0.75 (95% confidence interval: 0.72-0.79). The durations of in-hospital and total follow-up were 40,366 and 660,205 person-days, respectively. Total hospital expenditure was $31,818,701 and total efficacy was 1687.3 QALYs. For the lowest to highest risk quintile, the mean mortality risks were 0.30, 0.48, 0.61, 0.75, and 0.88, and the mean adjusted REC was $24,230, $43,042, $54,929, $84,973, and $149,095 per QALY, respectively.

CONCLUSIONS: Efficient allocation of limited and costly resources is more important when having to choose between groups of critically ill patients. Current analyzes of ECMO results should help identify candidates with the best prospects for survival while avoiding futile treatments.

PMID:35365930 | DOI: 10.1111/jep.13681

Sara H. Byrd