Cost-effectiveness of neonatal extracorporeal membrane oxygenation based on 7-year results from the United Kingdom Collaborative ECMO Trial
Related Experiment Video
Updated: Aug 9, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Stavros Petrou1, Matthias Bischof, Charlotte Bennett
1National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom. stavros.petrou@npeu.ox.ac.uk
Insights
Extracorporeal membrane oxygenation (ECMO) is a cost-effective treatment for newborns with severe respiratory failure, improving life years and reducing disability. This approach offers significant long-term benefits for infant health outcomes.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Health economics
Background:
- Severe respiratory failure in newborns presents significant challenges.
- Extracorporeal membrane oxygenation (ECMO) is an advanced life support technique.
- Long-term cost-effectiveness data for neonatal ECMO is crucial for clinical and policy decisions.
Purpose of the Study:
- To evaluate the long-term cost-effectiveness of neonatal ECMO.
- To compare ECMO versus conventional management for infants with severe respiratory failure.
- To assess health service utilization and costs up to seven years post-treatment.
Main Methods:
- Prospective economic evaluation alongside a randomized controlled trial.
- 185 infants with severe respiratory failure were randomized to ECMO or conventional care.
- Follow-up to 7 years of age, tracking health service use and costs.
Main Results:
- Neonatal ECMO significantly reduced death or severe disability.
- Mean 7-year health costs were £30,270 for ECMO vs. £10,229 for conventional care.
- Incremental cost per life year gained was £13,385; per disability-free life year gained was £23,566.
Conclusions:
- Neonatal ECMO demonstrates robust cost-effectiveness in childhood.
- The treatment offers a favorable net benefit, justifying its use.
- Provides rigorous evidence supporting ECMO for severe neonatal respiratory failure.
Objective:
To assess the long-term cost-effectiveness of extracorporeal membrane oxygenation (ECMO) for mature newborn infants with severe respiratory failure.
Methods:
A prospective economic evaluation was conducted alongside a pragmatic randomized, controlled trial in which 185 infants were randomly allocated to ECMO (n = 93) or conventional management (n = 92) and then followed up to 7 years of age. Information about their use of health services during the follow-up period was combined with unit costs (pound sterling, 2002-2003 prices) to obtain a net cost per child. The cost-effectiveness of neonatal ECMO was expressed in terms of incremental cost per additional life year gained and incremental cost per additional disability-free life year gained. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness-to-pay thresholds held by decision-makers for an additional life year and for an additional disability-free life year.
Results:
Over 7 years, neonatal ECMO was effective at reducing known death or severe disability. Mean health service costs during the first 7 years of life were 30,270 pound sterling in the ECMO group and 10,229 pound sterling in the conventional management group, generating a mean cost difference of 20,041 pound sterling that was statistically significant. The incremental cost per life year gained was estimated at 13,385 pound sterling. The incremental cost per disability-free life year gained was estimated at 23,566 pound sterling. At the notional willingness-to-pay threshold of 30,000 pound sterling for an additional life year, the probability that neonatal ECMO is cost-effective at 7 years was estimated at 0.98. This translated into a mean net benefit of 24,362 pound sterling for each adoption of neonatal ECMO rather than conventional management.
Conclusions:
This study provides rigorous evidence of the cost-effectiveness of neonatal ECMO during childhood.