儿童挽救性心脏体外膜肺氧合的成本效用分析
Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children.
作者信息
Mahle William T, Forbess Joseph M, Kirshbom Paul M, Cuadrado Angel R, Simsic Janet M, Kanter Kirk R
机构信息
Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine, 52 Executive Park S., Suite 523, Atlanta, GA 30329, USA.
出版信息
J Thorac Cardiovasc Surg. 2005 May;129(5):1084-90. doi: 10.1016/j.jtcvs.2004.08.012.
BACKGROUND
Indications for extracorporeal membrane oxygenation therapy have expanded to include cardiopulmonary arrest and support after congenital heart surgery. Data from a national registry have reported that cardiac patients have the poorest survival of all extracorporeal membrane oxygenation recipients. Concerns have been raised about the appropriateness of such an aggressive strategy, especially in light of the high costs and potential for long-term neurologic disability. We reviewed our experience with salvage cardiac extracorporeal membrane oxygenation to determine the cost-utility, which accounts for both costs and quality of life.
METHODS
Medical records of patients with congenital heart disease receiving salvage cardiac extracorporeal membrane oxygenation between January 2000 and May 2004 were reviewed. Charges for all medical care after the institution of extracorporeal membrane oxygenation were determined and converted to costs by published standards. The quality-of-life status of survivors was determined with the Health Utilities Index Mark II.
RESULTS
Salvage cardiac extracorporeal membrane oxygenation was instituted in 32 patients (18 for cardiopulmonary arrest and 14 for cardiac failure after heart surgery) at a median age of 2.0 months (range, 4 days to 5.1 years). Congenital heart disease was present in 27 (84%). The mean duration of extracorporeal membrane oxygenation support was 5.1 +/- 4.1 days. Survival to hospital discharge was 50%, including 1 patient bridged to heart transplantation. Survival to 1 year was 47%. The mean score of the Health Utilities Index for the survivors was 0.75 +/- 0.19 (range, 0.41-1.0). The median cost for hospital stay after the institution of extracorporeal membrane oxygenation was USD 156,324 per patient. The calculated cost-utility for salvage extracorporeal membrane oxygenation in this population was USD 24,386 per quality-adjusted life-year saved, which would be considered within the range of accepted cost-efficacy (< USD 50,000 per quality-adjusted life-year saved).
CONCLUSIONS
Salvage cardiac extracorporeal membrane oxygenation results in reasonable survival and is justified on a cost-utility basis.
背景
体外膜肺氧合治疗的适应证已扩大到包括心脏骤停和先天性心脏病手术后的支持治疗。来自国家登记处的数据报告称，在所有接受体外膜肺氧合治疗的患者中，心脏疾病患者的生存率最差。人们对这种激进策略的合理性提出了担忧，特别是考虑到高昂的成本和长期神经功能残疾的可能性。我们回顾了我们在挽救性心脏体外膜肺氧合治疗方面的经验，以确定成本效益，该效益同时考虑了成本和生活质量。
方法
回顾了2000年1月至2004年5月期间接受挽救性心脏体外膜肺氧合治疗的先天性心脏病患者的病历。确定了体外膜肺氧合治疗开始后所有医疗护理的费用，并根据公布的标准将其转换为成本。通过健康效用指数Mark II确定幸存者的生活质量状况。
结果
32例患者接受了挽救性心脏体外膜肺氧合治疗（18例因心脏骤停，14例因心脏手术后心力衰竭），中位年龄为2.0个月（范围为4天至5.1岁）。27例（84%）患有先天性心脏病。体外膜肺氧合支持的平均持续时间为5.1±4.1天。出院生存率为50%，其中1例患者过渡到心脏移植。1年生存率为47%。幸存者的健康效用指数平均评分为0.75±0.19（范围为0.41 - 1.0）。体外膜肺氧合治疗开始后住院的中位费用为每位患者156,324美元。该人群中挽救性体外膜肺氧合治疗的计算成本效益为每挽救一个质量调整生命年24,386美元，这将被认为在可接受的成本效益范围内（每挽救一个质量调整生命年<50,000美元）。
结论
挽救性心脏体外膜肺氧合治疗可带来合理的生存率，且在成本效益基础上是合理的。
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