St-Onge Maude, Fan Eddy, Mégarbane Bruno, Hancock-Howard Rebecca, Coyte Peter C
University of Toronto, Toronto, Ontario, Canada; Ontario Poison Centre, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada; Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
J Crit Care. 2015 Apr;30(2):437.e7-14. doi: 10.1016/j.jcrc.2014.10.010. Epub 2014 Oct 16.
Venoarterial extracorporeal membrane oxygenation represents an emerging and recommended option to treat life-threatening cardiotoxicant poisoning. The objective of this cost-effectiveness analysis was to estimate the incremental cost-effectiveness ratio of using venoarterial extracorporeal membrane oxygenation for adults in cardiotoxicant-induced shock or cardiac arrest compared with standard care.
Adults in shock or in cardiac arrest secondary to cardiotoxicant poisoning were studied with a lifetime horizon and a societal perspective. Venoarterial extracorporeal membrane oxygenation cost effectiveness was calculated using a decision analysis tree, with the effect of the intervention and the probabilities used in the model taken from an observational study representing the highest level of evidence available. The costs (2013 Canadian dollars, where $1.00 Canadian = $0.9562 US dollars) were documented with interviews, reviews of official provincial documents, or published articles. A series of one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were used to evaluate uncertainty in the decision model.
The cost per life year (LY) gained in the extracorporeal membrane oxygenation group was $145 931/18 LY compared with $88 450/10 LY in the non-extracorporeal membrane oxygenation group. The incremental cost-effectiveness ratio ($7185/LY but $34 311/LY using a more pessimistic approach) was mainly influenced by the probability of survival. The probabilistic sensitivity analysis identified variability in both cost and effectiveness.
Venoarterial extracorporeal membrane oxygenation may be cost effective in treating cardiotoxicant poisonings.
静脉-动脉体外膜肺氧合是一种新兴的、推荐用于治疗危及生命的心脏毒性药物中毒的方法。本成本效益分析的目的是估计与标准治疗相比，在心脏毒性药物导致的休克或心脏骤停的成人患者中使用静脉-动脉体外膜肺氧合的增量成本效益比。
以终生视角和社会视角对因心脏毒性药物中毒导致休克或心脏骤停的成人患者进行研究。使用决策分析树计算静脉-动脉体外膜肺氧合的成本效益，干预效果和模型中使用的概率取自一项代表现有最高证据水平的观察性研究。成本（2013年加元，1加元 = 0.9562美元）通过访谈、省级官方文件审查或已发表文章记录。使用一系列单因素敏感性分析和蒙特卡洛模拟的概率敏感性分析来评估决策模型中的不确定性。
体外膜肺氧合组每获得一个生命年（LY）的成本为145931美元/18个生命年，而非体外膜肺氧合组为88450美元/10个生命年。增量成本效益比（7185美元/生命年，但采用更悲观方法时为34311美元/生命年）主要受生存概率影响。概率敏感性分析确定了成本和效果的变异性。
静脉-动脉体外膜肺氧合在治疗心脏毒性药物中毒方面可能具有成本效益。
