Heart and Lung Center, Helsinki University Hospital, Finland.
Faculty of Medicine, University of Helsinki, Finland.
Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):333-341. doi: 10.1177/2048872619900090. Epub 2020 Jan 31.
The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown.
We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013-2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients' health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%.
The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€).
We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.
在心脏性休克中使用动静脉体外膜肺氧合的情况不断增加，但它的成本效益尚不清楚。
我们回顾性地研究了 2013 年至 2017 年期间在一家移植中心因难治性心脏性休克或心脏骤停而接受治疗的连续患者队列中使用动静脉体外膜肺氧合的成本效益。在我们的中心，所有有心脏移植资格的潜在难治性心脏性休克患者，以及部分心脏手术后患者都考虑使用动静脉体外膜肺氧合。我们评估了指数住院治疗的费用和一年的住院费用，以及患者的健康相关生活质量（响应率 71.7%）。根据数据和基于人群的预期寿命，我们计算了不贴现和贴现率为 3.5%时获得的质量调整生命年的数量和成本。
该队列包括 102 名患者（78 例为心脏性休克；24 例为心脏骤停），其中 67 名（65.7%）患者存活至出院，66 名（64.7%）患者存活至一年。每例住院幸存者的有效治疗费用为 242303 欧元。每位患者的指数住院治疗中位数住院费用为 129967 欧元（四分位距 150340 欧元）。不贴现时，治疗预计可获得的质量调整生命年数中位数为 20.9（标准差 9.7），每质量调整生命年的平均成本为 7474 欧元（四分位距 10973 欧元）。贴现率为 3.5%时，可获得 13.0（标准差 4.8）个质量调整生命年，每质量调整生命年的成本为 12642 欧元（四分位距 15059 欧元）。
我们发现，在移植中心环境中，对于难治性心脏性休克和心脏骤停患者，使用动静脉体外膜肺氧合从成本效益的角度来看是合理的。
