Abstract 174: Cost-Utility Analysis of Extracorporeal Cardiopulmonary Resuscitation in Patients With Cardiac Arrest

Abstract

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) provides cardiac and respiratory support and serves as a bridge to definitive therapy or to recovery. However, ECPR is resource intensive and evidence of clear survival benefit is lacking. In this study, we investigated the cost-utility of ECPR (cost/QALY) in cardiac arrest patients treated at our institution. Methods: We performed a retrospective review of ECPR patients who suffered cardiac arrest at our institution between 2012 and 2017. Charges for all medical care associated with ECPR and subsequent hospital care were recorded, including direct costs, indirect costs, operating costs and payer charges. The quality-of-life status of survivors was assessed with the Health Utilities Index Mark II. Results: ECPR was instituted in 24 patients (54% in-hospital [13 of 24]), mean age 49.8 ± 17.3 years, 71% male (17 of 24), and 58% African American (14 of 24). The mean and median duration of ECMO support was 3.2 and 2.7 days, respectively. The mean and median of total length of stay was 13.4 and 7.5 days, respectively. Survival to hospital discharge and 1-year survival were 17% (4 of 24) and 13% (3 of 23), respectively. The mean score of the Health Utilities Index Mark II at discharge for the survivors was 0.53 ± 0.23 (range, 0.32-0.84). The average operating cost for patients undergoing ECMO was $188,197 per patient. The calculated cost-utility for ECPR was $59,449/QALY gained. Conclusions: The calculated cost-utility for ECPR is within the threshold considered cost-effective in the United States (<$100,000/QALY gained). These results are comparable to the cost-effectiveness of orthotopic heart transplantation for end-stage heart failure. Larger studies are needed to assess the cost-utility of ECPR and to identify whether other factors, such as patient characteristics and type of cannula, may affect the cost-utility benefit.