Hsu Chiao-Po, Lee Wui-Chiang, Wei Hsiu-Mei, Sung Shih-Hsien, Huang Chun-Yang, Shih Chun-Che, Lu Tse-Min
Department of Medicine, School of Medicine, National Yang-Ming University, Taipei; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan.
J Epidemiol. 2015;25(4):321-31. doi: 10.2188/jea.JE20140027. Epub 2015 Mar 21.
No study to date has systematically examined use, expenditure, and outcomes associated with extracorporeal membrane oxygenation (ECMO) use in Taiwan. The aim of this study was to examine ECMO use, expenditure, and outcomes during an 11-year period in Taiwan.
Claims data were collected from the Taiwan National Health Insurance Research Database for patients who received ≥1 ECMO treatment between January 2000 and December 2010. Measurements included demographics, indications for ECMO use, length of hospital stay, outcome, and expenditure.
A total of 3969 patients received ECMO during the study period (median age: 54.6 years). The number of patients receiving ECMO increased from 52 in 2000 to 1045 in 2010. The major indication for ECMO was cardiovascular disease (68.7%), followed by respiratory disease (17.9%). Median length of hospital stay was 13 days in 2000 and 17 days in 2010. Median expenditure (New Taiwan dollars) was $604 317 in 2000 and $673 888 in 2010. Some variables significantly differed by age, sex, hospital setting, calendar year, and indication for ECMO, and were associated with in-hospital and after-discharge mortality.
ECMO use has increased dramatically in Taiwan over the last decade. The high mortality rate of ECMO users suggested that ECMO may be being used in Taiwan for situations in which it provides no added benefit. This situation may be a reflection of the current reimbursement criteria for National Health Insurance in Taiwan. Refinement of the indications for use of ECMO is suggested.
迄今为止，尚无研究系统地探讨台湾地区体外膜肺氧合（ECMO）的使用情况、费用及相关结果。本研究旨在调查台湾地区11年间ECMO的使用情况、费用及相关结果。
收集台湾全民健康保险研究数据库中2000年1月至2010年12月期间接受≥1次ECMO治疗患者的理赔数据。测量指标包括人口统计学特征、ECMO使用指征、住院时间、结局及费用。
研究期间共有3969例患者接受了ECMO治疗（中位年龄：54.6岁）。接受ECMO治疗的患者数量从2000年的52例增加至2010年的1045例。ECMO的主要使用指征是心血管疾病（68.7%），其次是呼吸系统疾病（17.9%）。2000年的中位住院时间为13天，2010年为17天。2000年的中位费用（新台币）为604317元，2010年为673888元。一些变量在年龄、性别、医院环境、日历年份及ECMO使用指征方面存在显著差异，并与住院期间及出院后的死亡率相关。
在过去十年中，台湾地区ECMO的使用显著增加。ECMO使用者的高死亡率表明，台湾地区可能在一些无法带来额外益处的情况下使用ECMO。这种情况可能反映了台湾地区现行的全民健康保险报销标准。建议完善ECMO的使用指征。
