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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
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Pre-hospital ECPR cost analysis and cost effectiveness modelling study.

Fredrick Zmudzki1, Brian Burns2, Natalie Kruit3

  • 1Époque Consulting Sydney Australia; Social Policy Research Centre, University of New South Wales Sydney NSW Australia; Care and Public Health Research Institute (CAPHRI) Maastricht University Maastricht the Netherlands.

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|January 5, 2025
PubMed
Summary

Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) shows promise for improving patient access and outcomes. Cost-effectiveness analysis suggests PH-ECPR is comparable to other medical interventions, with survival rates and service integration being key factors.

Keywords:
CPRCardiopulmonary resuscitationECMOECPRExtracorporeal membrane oxygenationExtracorporeal membrane oxygenation cardiopulmonary resuscitation

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Area of Science:

  • Cardiovascular Medicine
  • Emergency Medicine
  • Health Economics

Background:

  • Extracorporeal membrane oxygenation (ECMO) use in cardiopulmonary resuscitation (ECPR) is rising.
  • Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may enhance access and outcomes.
  • The cost-effectiveness of PH-ECPR requires thorough evaluation.

Purpose of the Study:

  • To determine the cost-effectiveness of prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA).
  • To model the economic impact of PH-ECPR strategies on healthcare systems.
  • To compare PH-ECPR cost-effectiveness with existing medical interventions.

Main Methods:

  • Cost analysis utilizing trial data, ambulance registries, geospatial modeling, and in-hospital costings.
  • Markov modeling to integrate PH-ECPR costs with patient outcomes across various strategies.
  • Calculation of cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs) using established formulas and sensitivity analysis.

Main Results:

  • Average prehospital ECPR cost per patient estimated at $12,741 AUD, equating to approximately $44,000 per QALY.
  • Incorporating a 10% kidney organ donation rate reduced the cost per QALY to $22,000.
  • Patient survival rates, team allocation time, and organ donation significantly influence PH-ECPR cost-effectiveness.

Conclusions:

  • PH-ECPR service strategies are likely cost-effective and comparable to other medical interventions.
  • Optimizing survival rates and integrating PH-ECPR services into non-ECPR clinical tasks are crucial for cost-effectiveness.
  • Further analysis supports the implementation of PH-ECPR as a viable healthcare strategy.