Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Resuscitation. 2019 Oct;143:150-157. doi: 10.1016/j.resuscitation.2019.08.024. Epub 2019 Aug 29.
This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment.
A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2-4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY).
Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922-14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192-15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478-16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357-19,400) euro per extra QALY per IHCA patient. For WTP thresholds of 0-9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most cost-effective strategy.
Given that conventional WTP thresholds in Europe and North-America lie between 50,000-100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR.
本研究旨在评估体外心肺复苏（ECPR）治疗院内心脏骤停的成本效益。
基于现有文献，构建决策树和马尔可夫模型。模型条件为年龄、Charlson 合并症指数（CCI）和性别。考虑了三种治疗策略：年龄合并 Charlson 合并症指数（ACCI）低于不同阈值（2-4）的患者进行 ECPR、对所有人进行 ECPR（EALL）和对无人进行 ECPR（NE）。使用每增加一个质量调整生命年（QALY）的成本进行成本效益评估。
对 ACCI 低于 2 分的符合条件的患者进行治疗，每例 IHCA 患者增加一个 QALY 的成本为 8394 欧元（95%CI：4922-14911 欧元）；对 ACCI 低于 3 分的符合条件的患者进行治疗，每例 IHCA 患者增加一个 QALY 的成本为 8825 欧元（95%CI：5192-15777 欧元）；对 ACCI 低于 4 分的符合条件的患者进行治疗，每例 IHCA 患者增加一个 QALY 的成本为 9311 欧元（95%CI：5478-16690 欧元）；对所有符合条件的患者进行 ECPR 治疗，每例 IHCA 患者增加一个 QALY 的成本为 10818 欧元（95%CI：6357-19400 欧元）。对于 0-9500 欧元的 WTP 阈值，NE 具有最高的概率成为最具成本效益的策略。对于 9500 至 12500 欧元的 WTP 阈值，对 ACCI 低于 4 分的符合条件的患者进行治疗具有最高的概率成为最具成本效益的策略。对于 12500 欧元或更高的 WTP 阈值，发现 EALL 最有可能成为最具成本效益的策略。
鉴于欧洲和北美常规 WTP 阈值在 50000-100000 欧元或美元之间，从医疗保健角度来看，ECPR 可以被认为是一种成本效益好的治疗方法。需要进一步研究来验证 ECPR 的有效性，重点关注 ECPR 并发症的长期影响。
