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US and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review

Abstract

Context

The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established.

Objective

To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types.

Data Sources

Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms ‘ECMO’ AND ‘health expenditures’ or ‘resource use’ or ‘costs’ or ‘cost analysis’ or ‘cost(-)effectiveness’ or ‘cost(-)benefit’ or ‘cost(-)utility’ or ‘economic(-)evaluation’ or ‘economic’ or ‘QALY’ or ‘cost per quality-adjusted life year’.

Study Selection

Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs.

Data Extraction

Data extraction was completed by one author, using predefined criteria.

Results

From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g. range of total in-hospital costs of treatment: USD 42,554–537,554 [in 2013 values]). In the USA, the reported costs of ECMO were highest for CDH repair, followed by cardiac conditions, and lowest for respiratory conditions. The US charges were highest for cardiac conditions. Outside the USA, the ECMO cost was highest for cardiac conditions, followed by respiratory conditions, and lowest for CDH repair. No non-US studies reported charges.

Conclusion

The current literature shows that a large variation exists in the in-hospital cost estimates for ECMO. Further research is needed to understand how the diagnosis, setting and other factors relate to this variation in the cost of this technology. Reliable costing methodologies and cost information will be critical to inform policymakers and stakeholders wishing to maximize the value of advanced medical technologies such as ECMO.

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Acknowledgments

The authors have no financial or non-financial conflicts of interest. All authors contributed to the writing and revision of this article, and Michael J. Harvey is its guarantor. The authors would like to thank Mr. Anup Das for his helpful comments during the revision of the article.

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Correspondence to Michael J. Harvey.

Appendix 1: Electronic Search Strategy

Appendix 1: Electronic Search Strategy

PubMed Database

# Search term PubMed query translation
1 ECMO ‘extracorporeal membrane oxygenation’ [MeSH Terms] OR (‘extracorporeal’ [All Fields] AND ‘membrane’ [All Fields] AND ‘oxygenation’ [All Fields]) OR ‘extracorporeal membrane oxygenation’ [All Fields] OR ‘ecmo’ [All Fields]
2 Health expenditures ‘health expenditures‘ [MeSH Terms] OR (‘health‘ [All Fields] AND ‘expenditures‘ [All Fields]) OR ‘health expenditures‘ [All Fields]
3 Resource use ‘health resources’ [MeSH Terms] OR (‘health’ [All Fields] AND ‘resources’ [All Fields]) OR ‘health resources‘ [All Fields] OR ‘resource‘ [All Fields]
4 Costs ‘costs and cost analysis’ [MeSH Terms] OR (‘costs’ [All Fields] AND ‘cost’ [All Fields] AND ‘analysis’ [All Fields]) OR ‘costs and cost analysis‘ [All Fields] OR ‘costs‘ [All Fields]
5 Cost analysis ‘costs and cost analysis’ [MeSH Terms] OR (‘costs’ [All Fields] AND ‘cost’ [All Fields] AND ‘analysis’ [All Fields]) OR ‘costs and cost analysis‘ [All Fields] OR (‘cost‘ [All Fields] AND ‘analysis‘ [All Fields]) OR ‘cost analysis‘ [All Fields]
6 Cost effectiveness ‘cost-benefit analysis‘ [MeSH Terms] OR (‘cost-benefit‘ [All Fields] AND ‘analysis‘ [All Fields]) OR ‘cost-benefit analysis‘ [All Fields] OR (‘cost‘ [All Fields] AND ‘effectiveness‘ [All Fields]) OR ‘cost effectiveness‘ [All Fields]
7 Cost-effectiveness Same as #6
8 Cost benefit ‘cost-benefit analysis’ [MeSH Terms] OR (‘cost-benefit’ [All Fields] AND ‘analysis’ [All Fields]) OR ‘cost-benefit analysis‘ [All Fields] OR (‘cost‘ [All Fields] AND ‘benefit‘ [All Fields]) OR ‘cost benefit‘ [All Fields]
9 Cost–benefit Same as #8
10 Cost utility (‘economics’ [Subheading] OR ‘economics’ [All Fields] OR ‘cost’ [All Fields] OR ‘costs and cost analysis’ [MeSH Terms] OR (‘costs‘ [All Fields] AND ‘cost‘ [All Fields] AND ‘analysis‘ [All Fields]) OR ‘costs and cost analysis‘ [All Fields]) AND ‘utility’ [All Fields]
11 Cost–utility ‘cost-utility’ [All Fields]
12 Economic evaluation ‘cost-benefit analysis‘ [MeSH Terms] OR (‘cost-benefit‘ [All Fields] AND ‘analysis‘ [All Fields]) OR ‘cost-benefit analysis‘ [All Fields] OR (‘economic‘ [All Fields] AND ‘evaluation‘ [All Fields]) OR ‘economic evaluation‘ [All Fields]
13 Economic ‘economics’ [MeSH Terms] OR ‘economics’ [All Fields] OR ‘economic’ [All Fields]
14 QALY ‘quality-adjusted life years’ [MeSH Terms] OR (‘quality-adjusted’ [All Fields] AND ‘life’ [All Fields] AND ‘years‘ [All Fields]) OR ‘quality-adjusted life years‘ [All Fields] OR ‘qaly‘ [All Fields]
15 Cost per quality-adjusted life year (‘economics‘ [Subheading] OR ‘economics‘ [All Fields] OR ‘cost‘ [All Fields] OR ‘costs and cost analysis‘ [MeSH Terms] OR (‘costs‘ [All Fields] AND ‘cost‘ [All Fields] AND ‘analysis‘ [All Fields]) OR ‘costs and cost analysis‘ [All Fields]) AND (‘Pediatr Endocrinol Rev‘ [Journal] OR ‘per‘ [All Fields]) AND (‘quality-adjusted life years‘ [MeSH Terms] OR (‘quality-adjusted‘ [All Fields] AND ‘life‘ [All Fields] AND ‘years‘ [All Fields]) OR ‘quality-adjusted life years‘ [All Fields] OR (‘quality‘ [All Fields] AND ‘adjusted‘ [All Fields] AND ‘life‘ [All Fields] AND ‘year‘ [All Fields]) OR ‘quality adjusted life year‘ [All Fields])

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Harvey, M.J., Gaies, M.G. & Prosser, L.A. US and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review. Appl Health Econ Health Policy 13, 341–357 (2015). https://doi.org/10.1007/s40258-015-0170-9

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Keywords

  • Incremental Cost
  • Congenital Diaphragmatic Hernia
  • Respiratory Condition
  • Purchase Power Parity
  • Extracorporeal Membrane Oxygenation