Background: This study aimed to estimate the cost-effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest treatment. Methods: A decision tree and Markov model were constructed based on current literature. The model was conditional on age, Charlson Comorbidity Index (CCI) and sex. Three treatment strategies were considered: ECPR for patients with an Age-Combined Charlson Comorbidity Index (ACCI) below different thresholds (2–4), ECPR for everyone (EALL), and ECPR for no one (NE). Cost-effectiveness was assessed with costs per quality-of-life adjusted life years (QALY). Measurements and main results: Treating eligible patients with an ACCI below 2 points costs 8394 (95% CI: 4922–14,911) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 3 costs 8825 (95% CI: 5192–15,777) euro per extra QALY per IHCA patient; treating eligible patients with an ACCI below 4 costs 9311 (95% CI: 5478–16,690) euro per extra QALY per IHCA patient; treating every eligible patient with ECPR costs 10,818 (95% CI: 6357–19,400) euro per extra QALY per IHCA patient. For WTP thresholds of 0–9500 euro, NE has the highest probability of being the most cost-effective strategy. For WTP thresholds between 9500 and 12,500, treating eligible patients with an ACCI below 4 has the highest probability of being the most cost-effective strategy. For WTP thresholds of 12,500 or higher, EALL was found to have the highest probability of being the most cost-effective strategy. Conclusions: Given that conventional WTP thresholds in Europe and North-America lie between 50,000–100,000 euro or U.S. dollars, ECPR can be considered a cost-effective treatment after in-hospital cardiac arrest from a healthcare perspective. More research is necessary to validate the effectiveness of ECPR, with a focus on the long-term effects of complications of ECPR.

Additional Metadata
Keywords Cost-effectiveness, Decision model, Extracorporeal life support, Extracorporeal membrane oxygenation, In-hospital cardiac arrest, Intensive care
Persistent URL dx.doi.org/10.1016/j.resuscitation.2019.08.024, hdl.handle.net/1765/119577
Journal Resuscitation
Citation
Gravesteijn, B.Y. (Benjamin Y.), Schluep, M. (Marc), Voormolen, D.C. (Daphne C.), van der Burgh, A.C. (Anna C.), dos Reis Miranda, D, Hoeks, S.E, & Endeman, H. (2019). Cost-effectiveness of extracorporeal cardiopulmonary resuscitation after in-hospital cardiac arrest: A Markov decision model. Resuscitation, 143, 150–157. doi:10.1016/j.resuscitation.2019.08.024