Cost-effectiveness of Extracorporeal Cardiopulmonary Resuscitation after in-hospital cardiac arrest: a Markov decision model.

Gravesteijn, Benjamin Y; Schluep, Marc; Voormolen, Daphne C; van der Burgh, Anna C; Dos Reis Miranda, Dinís; Hoeks, Sanne E; Endeman, Henrik

BACKGROUND This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment. METHODS 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). MEASUREMENTS AND MAIN RESULTS Treating eligible patients with an ACCI below 2 points costs 8,394 (95% CI: 4,922 - 14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8,825 (95% CI: 5,192 - 15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5,478 - 16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10818 (95% CI: 6,357 - 19,400) euro per extra QALY per IHCA patient. For WTP thresholds of 0 to 9,500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9,500 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. CONCLUSIONS 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.