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Published on: January 17, 2025
Hospital Costs for Neonates and Children Supported with Extracorporeal Membrane Oxygenation
David Faraoni1, Viviane G Nasr1, James A DiNardo1
1Department of Anesthesiology, Peri-operative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Insights
Extracorporeal membrane oxygenation (ECMO) hospitalization is costly for children. Factors like diagnosis, hospital size, and complications significantly impact resource use, highlighting the need for cost-management strategies.
Area of Science:
- Pediatric critical care medicine
- Health economics
- Healthcare resource utilization
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for critically ill children.
- Understanding the drivers of high healthcare costs associated with ECMO is crucial for resource allocation and financial planning.
Purpose of the Study:
- To identify patient and hospital characteristics associated with high hospitalization costs in pediatric patients undergoing ECMO.
- To pinpoint a cohort of high-resource users within the ECMO population.
Main Methods:
- Analysis of hospital charges from the 2012 Health Care Cost and Use Project Kid's Inpatient Database for 1465 pediatric ECMO patients.
- Categorization of patients into six diagnostic groups and costs into four quartiles.
- Comparison of ECMO costs with costs for bone marrow, liver, and kidney transplants.
Main Results:
- Median ECMO hospitalization cost was $230,425.
- Factors associated with higher costs included cardiac surgery diagnosis, smaller hospital size (<399 beds), Midwest/West locations, renal failure, and thromboembolic complications.
- ECMO survivor cost ($519,450) exceeded that of bone marrow, liver, or kidney transplant survivors.
Conclusions:
- Pediatric ECMO hospitalizations represent a significant financial burden.
- Diagnosis, hospital characteristics, and the occurrence of complications are key determinants of ECMO-related costs.
Objective:
To assess the characteristics associated with high hospital cost for patients receiving extracorporeal membrane oxygenation (ECMO) to identify a cohort of high-resource users.
Study Design:
Cost for hospitalization, during which ECMO support was used, was calculated from hospital charges reported in the 2012 Health Care Cost and Use Project Kid's Inpatient Database. Patients were categorized into 6 diagnostic groups: (1) cardiac surgery; (2) nonsurgical heart disease; (3) congenital diaphragmatic hernia; (4) neonatal respiratory failure; (5) pediatric respiratory failure; and (6) sepsis. We categorized cost into 4 groups based on quartiles. We compared ECMO cost with hospital cost for bone marrow, liver, and kidney transplants performed during the same year.
Results:
Median hospital cost for children supported with ECMO (n = 1465) was $230,425 (IQR: $126,599-$420,960). In a multivariable model, lower cost was associated with neonatal respiratory failure (OR: 0.19) and sepsis (OR 0.53) compared with cardiac surgery (OR: 1.88), whereas greater cost was associated with smaller hospital bed-size <99 (OR: 3.49) and 100-399 beds (OR: 3.03) compared with hospitals >400 beds, hospital location (Midwest [OR: 1.74] and West [OR 2.18] compared with North-East), and complications such as renal failure (OR: 3.77) and thromboembolic complications (OR 1.60). Hospital cost per survivor was greater for ECMO ($519,450) than bone marrow transplantation ($207,212), liver ($231,755), or kidney transplantation ($82,008) groups.
Conclusions:
Hospitalization cost for children supported with ECMO is high. Diagnosis, hospital characteristics, and presence of complications are associated with increased cost.
