The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis

• Published in: Revista Brasileira de terapia intensiva Vol. 26; no. 3; pp. 253 - 262
• Main Authors: Park, Marcelo, Mendes, Pedro Vitale, Zampieri, Fernando Godinho, Azevedo, Luciano Cesar Pontes, Costa, Eduardo Leite Vieira, Antoniali, Fernando, Ribeiro, Gustavo Calado de Aguiar, Caneo, Luiz Fernando, da Cruz Neto, Luiz Monteiro, Carvalho, Carlos Roberto Ribeiro, Trindade, Evelinda Marramon
• Format: Journal Article
• Language: English
• Published: Brazil Associação Brasileira de Medicina intensiva 01-07-2014
• Subjects: Adult; Brazil; Databases, Factual; Decision Trees; Extracorporeal Membrane Oxygenation - economics; Extracorporeal Membrane Oxygenation - methods; Humans; Original; Oxygen - blood; Partial Pressure; Quality-Adjusted Life Years; Respiratory Distress Syndrome, Adult - economics; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory Distress Syndrome, Adult - therapy; Severity of Illness Index; Survival Rate; Brazil
• ISSN: 0103-507X; 1982-4335
• DOI: 10.5935/0103-507X.20140036

To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.
A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.
The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100 mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.
The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.