Cost effectiveness of pre-hospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – An analysis of the PRECARE study

TL;DR

This study evaluates whether pre-hospital extracorporeal cardiopulmonary resuscitation is cost-effective for cardiac arrest patients in Sydney.

Contribution

The study provides the first cost-effectiveness analysis of pre-hospital ECPR using real-world data and a Markov model.

Findings

31% of patients survived to hospital discharge with good neurological outcomes.

The cost-effectiveness ratio was AUD 34,000 per quality-adjusted life year when ECPR occupied 15% of team time.

Exclusive dedication to ECPR increased costs to AUD 95,000 per quality-adjusted life year.

Abstract

While the use of pre-hospital extracorporeal cardiopulmonary resuscitation for refractory out of hospital cardiac arrest is increasing, there is little data on whether it is cost-effective. This study investigated its cost-effectiveness of based on our current study data.

Using data from the PRECARE trial, the New South Wales Ambulance Cardiac Arrest Registry (CAR) and in-hospital costings, we performed a cost effectiveness analysis of pre-hospital extracorporeal cardiopulmonary resuscitation (ECPR). A Markov model was used to integrate PRECARE service costs and patient outcomes, team time allocation to ECPR, patient volume, organ donation and alternate pre-hospital delivery strategies. Bridging formulae were used with ECPR survivor Cerebral Performance Category scores to estimate Quality Adjusted Life Years and Incremental Cost Effectiveness Ratios. Probabilistic sensitivity analysis was undertaken to assess the joint uncertainty in model parameters.

Sixteen patients were analysed (mean age 52 ± 10 years). Five patients (31%) survived to hospital discharge; all with a cerebral performance category score of 1 or 2. Three (60%) of survivors returned to work during the study period. There was one organ donor. The total cost per patient was $94,460 (±$103,455), with a base-case incremental cost-effectiveness ratio of AUD 34,000 per quality adjusted life year (assuming 100 patients per year, and ECPR cases occupying 15% of the PH-ECPR team’s time). If the PRECARE team were exclusively dedicated to ECPR cases, the cost per quality adjusted life year would increase to $95,000.

PH-ECPR in Sydney is likely to be cost-effective, assuming a 15% allocation of prehospital team time to ECPR. Survival rate, organ donation and the team’s ability to perform other clinical tasks when not performing ECPR are key factors influencing cost effectiveness. A PH team exclusively dedicated to ECPR is much less cost-effective.

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