Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: A modelling study

Tan N Doan; Stephen Rashford; Jason Pincus; Emma Bosley

doi:10.1016/j.resplu.2022.100309

Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: A modelling study

Resusc Plus. 2022 Sep 24:12:100309. doi: 10.1016/j.resplu.2022.100309. eCollection 2022 Dec.

Authors

Tan N Doan^{1

2}, Stephen Rashford¹, Jason Pincus³, Emma Bosley^{1

4}

Affiliations

¹ Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia.
² Department of Medicine at The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
³ Department of Intensive Care Medicine and Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
⁴ School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) is a method of CPR that passes the patient's blood through an extracorporeal membrane oxygenation (ECMO) device to provide mechanical haemodynamic and oxygenation support in cardiac arrest patients who are not responsive to conventional CPR (C-CPR). E-CPR is being adopted rapidly worldwide despite the absence of high quality trial data and its substantial cost. Published cost-effectiveness data for E-CPR are scarce.

Methods: We developed a mathematical model to estimate the cost-effectiveness of E-CPR relative to C-CPR in adult patients with refractory out-of-hospital cardiac arrest (OHCA). The model was a combination of a decision tree for the acute treatment phase and a Markov model for long-term periods. Cost-effectiveness was evaluated from the Australian health system perspective over lifetime. Cost-effectiveness was expressed as Australian dollars (AUD, 2021 value) per quality-adjusted life year (QALY) gained. Variables were parameterised using published data. Probabilistic and univariate sensitivity analyses were performed.

Results: The incremental cost-effectiveness ratio (ICER) of E-CPR was estimated to be AUD 45,716 per QALY gained over lifetime (95% uncertainty range 22,102-292,904). The cost-effectiveness of E-CPR was most sensitive to the outcome of the therapy.

Conclusion: E-CPR has median ICER that is below common accepted willingness-to-pay thresholds. Local factors within the health care system need to be considered to determine the feasibility of implementing an effective E-CPR program.

Keywords: Cost-effectiveness; E-CPR; ECMO; Out-of-hospital cardiac arrest.