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Cost of extracorporeal life support in pediatric patients with acute respiratory failure
A Vats1, R Pettignano, S Culler
1Division of Critical Care Medicine, Egleston Children's Hospital at Emory University, Atlanta, GA, USA.
Insights
Extracorporeal life support (ECLS) significantly improves survival in pediatric patients with acute hypoxemic respiratory failure (AHRF), despite high costs. The cost-effectiveness, measured in cost per life-year saved, demonstrates ECLS as a valuable intervention.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Respiratory Physiology
Background:
- Acute hypoxemic respiratory failure (AHRF) in children carries a high mortality risk.
- Extracorporeal life support (ECLS) offers a potential life-saving therapy for severe pediatric respiratory failure.
Purpose of the Study:
- To evaluate the impact of ECLS on mortality rates in pediatric patients diagnosed with AHRF.
- To determine the associated hospital charges and cost-effectiveness of ECLS in this patient population.
Main Methods:
- Retrospective review of medical records and hospital charges for pediatric patients receiving ECLS.
- Comparison of observed mortality with predicted mortality using the Pediatric Respiratory Failure score.
- Calculation of cost per life-year saved for ECLS survivors.
Main Results:
- The study identified 20 pediatric patients with AHRF treated with ECLS.
- Observed mortality was 20%, significantly lower than the predicted mortality of 83%.
- Median hospital charges were $199,096, equating to a cost of $4,190 per life-year saved.
Conclusions:
- ECLS is associated with considerable costs but demonstrates a favorable impact on survival for pediatric AHRF.
- Cost-per-life-year analysis suggests ECLS is a cost-effective intervention.
- Findings provide a benchmark for evaluating newer therapies and for cost analyses at other institutions.
Objectives:
To determine the impact of extracorporeal life support (ECLS) on mortality in pediatric patients with acute hypoxemic respiratory failure (AHRF) at our institution; and to calculate the hospital charges associated with the use of ECLS.
Design:
Retrospective review of medical records and hospital charges.
Setting:
Pediatric intensive care unit (ICU) of a university-affiliated children's hospital.
Patients:
Twenty patients admitted to the pediatric ICU between 1991 and 1995 for AHRF who received ECLS as a part of their hospital course.
Interventions:
Predicted mortality was calculated using the Pediatric Respiratory Failure score and was compared with survival at the time of hospital discharge. Hospital charges were used as a proxy for resource utilization. Cost-per-life-year-saved calculations were performed based on a normal life expectancy for survivors.
Measurements And Main Results:
Twenty patients were identified. The median age was 4.83 yrs. The median duration of ECLS was 9 days, with 19.5 days in the pediatric ICU and 23.5 days for the entire hospital length of stay. The observed mortality rate for these patients was 20%. Median predicted mortality rate based on the Pediatric Respiratory Failure score calculation was 83%. The hospital charges incurred by these patients was a median of $199,096. Based on a normal life expectancy for survivors, this results in a cost of $4,190/life-year.
Conclusions:
ECLS for the pediatric patient with AHRF is done at a considerable cost. However, ECLS affects survival favorably, and compares favorably when considering cost/life-year calculations. The data presented in this study may serve as a benchmark for comparison with newer therapies (i.e., liquid ventilation, nitric oxide). These data also provide a framework for cost-based analyses at other ECLS institutions.