Zmudzki Fredrick, Burns Brian, Kruit Natalie, Song Changle, Moylan Emily, Vachharajani Hemal, Buscher Hergen, Southwood Timothy J, Forrest Paul, Dennis Mark
Époque Consulting Sydney Australia; Social Policy Research Centre, University of New South Wales Sydney NSW Australia; Care and Public Health Research Institute (CAPHRI) Maastricht University Maastricht the Netherlands.
Faculty of Medicine and Health, University of Sydney Sydney Australia; Aeromedical Operations, New South Wales, Ambulance Sydney Australia.
Resuscitation. 2025 Mar;208:110488. doi: 10.1016/j.resuscitation.2024.110488. Epub 2025 Jan 3.
The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined.
Cost analyses of PH-ECPR was performed utilizing current PH-ECPR trial, NSW Ambulance Cardiac Arrest Registry (CAR), geospatial modelling and in-hospital costings data. Markov modelling was completed to combine the PH-ECPR cost analysis with reported patient outcomes across multiple ECPR strategies. Bridging formulae from ECPR survivor cerebral performance category (CPC) scores were used to estimate cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs). Probabilistic Sensitivity Analysis was completed to assess the probability of cost effectiveness for base case and PH-ECPR strategy variations.
Assuming a base case of 100 patients per year, with a 25% team allocation to ECPR, the average pre-hospital ECPR cost per patient was $12,741 and total of $88,656 AUD equating to approximately $44,000 per QALY. Addition of a conservative 10% kidney organ donation rate reduces the cost per QALY to $22,000. Patient survival rate, the proportion of time the pre-hospital ECPR team are allocated to ECPR and organ donation significantly impact PH-ECPR cost effectiveness.
Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness.
在心肺复苏（ECPR）期间使用体外膜肺氧合（ECMO）的情况正在增加。用于院外心脏骤停（OHCA）的院前ECPR（PH-ECPR）可能会改善可及性和平等性以及治疗效果，但其成本效益尚未确定。
利用当前的PH-ECPR试验、新南威尔士州救护车心脏骤停登记处（CAR）、地理空间建模和住院费用数据，对PH-ECPR进行成本分析。完成马尔可夫建模，将PH-ECPR成本分析与多种ECPR策略报告的患者结局相结合。使用ECPR幸存者脑功能分类（CPC）评分的桥接公式来估计每质量调整生命年（QALY）的成本和增量成本效益比（ICER）。完成概率敏感性分析，以评估基础病例和PH-ECPR策略变化的成本效益概率。
假设每年有100例患者的基础病例，25%的团队分配到ECPR，每位患者的院前ECPR平均成本为12,741澳元，总计88,656澳元，相当于每QALY约44,000澳元。保守地增加10%的肾脏器官捐赠率可将每QALY成本降低至22,000澳元。患者生存率、院前ECPR团队分配到ECPR的时间比例和器官捐赠对PH-ECPR成本效益有显著影响。
初步成本分析和建模表明，PH-ECPR服务策略可能具有成本效益，并且与其他医疗干预措施相当。生存率和服务整合到非ECPR临床任务中是影响成本效益的关键因素。
