Serviço de Medicina Interna, Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.
Escritório de Pesquisa PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, RS - Brasil.
Arq Bras Cardiol. 2024 Jul;121(8):e20230672. doi: 10.36660/abc.20230672.
Refractory cardiogenic shock (CS) is associated with high mortality rates, and the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a therapeutic option has generated discussions. Therefore, its cost-effectiveness, especially in low- and middle-income countries like Brazil, remains uncertain.Objectives: To conduct a cost-utility analysis from the Brazilian Unified Health System perspective to assess the cost-effectiveness of VA-ECMO combined with standard care compared to standard care alone in adult refractory CS patients.
We followed a cohort of refractory CS patients treated with VA-ECMO in tertiary care centers located in Southern Brazilian. We collected data on hospital outcomes and costs. We conducted a systematic review to supplement our data and utilized a Markov model to estimate incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) and per life-year gained.
In the base-case analysis, VA-ECMO yielded an ICER of Int$ 37,491 per QALY. Sensitivity analyses identified hospitalization cost, relative risk of survival, and VA-ECMO group survival as key drivers of results. Probabilistic sensitivity analysis favored VA-ECMO, with a 78% probability of cost-effectiveness at the recommended willingness-to-pay threshold.
Our study suggests that, within the Brazilian Health System framework, VA-ECMO may be a cost-effective therapy for refractory CS. However, limited efficacy data and recent trials questioning its benefit in specific patient subsets highlight the need for further research. Rigorous clinical trials, encompassing diverse patient profiles, are essential to confirm cost-effectiveness and ensure equitable access to advanced medical interventions within healthcare systems, particularly in socio-economically diverse countries like Brazil.
难治性心源性休克（CS）与高死亡率相关，使用静脉动脉体外膜肺氧合（VA-ECMO）作为治疗选择引发了讨论。因此，其成本效益，特别是在巴西等中低收入国家，仍不确定。
从巴西统一卫生系统的角度进行成本效益分析，评估 VA-ECMO 联合标准治疗与单纯标准治疗相比在成人难治性 CS 患者中的成本效益。
我们对在巴西南部三级护理中心接受 VA-ECMO 治疗的难治性 CS 患者进行了队列研究。我们收集了医院结局和成本数据。我们进行了系统评价以补充我们的数据，并使用马尔可夫模型来估计每质量调整生命年（QALY）和每生命年增加的增量成本效益比（ICER）。
在基本分析中，VA-ECMO 的每 QALY 成本效益比为 Int$37,491。敏感性分析确定住院成本、生存的相对风险和 VA-ECMO 组的生存率是结果的关键驱动因素。概率敏感性分析有利于 VA-ECMO，在推荐的支付意愿阈值下，有 78%的成本效益可能性。
我们的研究表明，在巴西卫生系统框架内，VA-ECMO 可能是难治性 CS 的一种具有成本效益的治疗方法。然而，有限的疗效数据和最近的试验质疑其在特定患者亚组中的益处，突出了进一步研究的必要性。严格的临床试验，包括不同的患者特征，对于在医疗保健系统内确认成本效益并确保公平获得先进的医疗干预措施至关重要，特别是在巴西等社会经济多样化的国家。
