HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph M. Forbess Paul M. Kirshbom Kirk R. Kanter Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mahle, W. T. Articles by Kanter, K. R. Search for Related Content PubMed PubMed Citation Articles by Mahle, W. T. Articles by Kanter, K. R. Related Collections Congenital - acyanotic Congenital - cyanotic Extracorporeal circulation

J Thorac Cardiovasc Surg 2005;129:1084-1090
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children

^a Childrens Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
^b Emory Clinic, Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga

Received for publication June 11, 2004; revisions received August 2, 2004; accepted for publication August 5, 2004.

^_* Address for reprints: William T. Mahle, MD, Childrens Healthcare of Atlanta, Emory University School of Medicine, 52 Executive Park S, Ste 52, Atlanta, GA 30329 (E-mail: mahlew{at}kidsheart.com).

BACKGROUND: Indications for extracorporeal membrane oxygenation therapy have expanded to include cardiopulmonary arrest and support after congenital heart surgery. Data from a national registry have reported that cardiac patients have the poorest survival of all extracorporeal membrane oxygenation recipients. Concerns have been raised about the appropriateness of such an aggressive strategy, especially in light of the high costs and potential for long-term neurologic disability. We reviewed our experience with salvage cardiac extracorporeal membrane oxygenation to determine the cost-utility, which accounts for both costs and quality of life.

METHODS: Medical records of patients with congenital heart disease receiving salvage cardiac extracorporeal membrane oxygenation between January 2000 and May 2004 were reviewed. Charges for all medical care after the institution of extracorporeal membrane oxygenation were determined and converted to costs by published standards. The quality-of-life status of survivors was determined with the Health Utilities Index Mark II.

RESULTS: Salvage cardiac extracorporeal membrane oxygenation was instituted in 32 patients (18 for cardiopulmonary arrest and 14 for cardiac failure after heart surgery) at a median age of 2.0 months (range, 4 days to 5.1 years). Congenital heart disease was present in 27 (84%). The mean duration of extracorporeal membrane oxygenation support was 5.1 ± 4.1 days. Survival to hospital discharge was 50%, including 1 patient bridged to heart transplantation. Survival to 1 year was 47%. The mean score of the Health Utilities Index for the survivors was 0.75 ± 0.19 (range, 0.41–1.0). The median cost for hospital stay after the institution of extracorporeal membrane oxygenation was $156,324 per patient. The calculated cost-utility for salvage extracorporeal membrane oxygenation in this population was $24,386 per quality-adjusted life-year saved, which would be considered within the range of accepted cost-efficacy (<$50,000 per quality-adjusted life-year saved).

CONCLUSIONS: Salvage cardiac extracorporeal membrane oxygenation results in reasonable survival and is justified on a cost-utility basis.

This article has been cited by other articles:

				V. Mishra, J. L. Svennevig, J. F. Bugge, S. Andresen, A. Mathisen, H. Karlsen, I. Khushi, and T. P. Hagen Cost of extracorporeal membrane oxygenation: evidence from the Rikshospitalet University Hospital, Oslo, Norway Eur. J. Cardiothorac. Surg., February 1, 2010; 37(2): 339 - 342. [Abstract] [Full Text] [PDF]

				W. T. Mahle, G. Ianucci, R. N. Vincent, and K. R. Kanter Costs Associated With Ventricular Assist Device Use in Children Ann. Thorac. Surg., November 1, 2008; 86(5): 1592 - 1597. [Abstract] [Full Text] [PDF]

				R. R. Thiagarajan, P. C. Laussen, P. T. Rycus, R. H. Bartlett, and S. L. Bratton Extracorporeal Membrane Oxygenation to Aid Cardiopulmonary Resuscitation in Infants and Children Circulation, October 9, 2007; 116(15): 1693 - 1700. [Abstract] [Full Text] [PDF]

				K. D. Bakshi, B. Vaidyanathan, K. R. Sundaram, S. J. Roth, K. Shivaprakasha, S. G. Rao, S. G. Nair, S. Chengode, and R. K. Kumar Determinants of early outcome after neonatal cardiac surgery in a developing country J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 765 - 771. [Abstract] [Full Text] [PDF]

				G. de Lissovoy, L. S. Matza, H. Green, M. Werner, and T. Edgar Cost-effectiveness of Intrathecal Baclofen Therapy for the Treatment of Severe Spasticity Associated With Cerebral Palsy J Child Neurol, January 1, 2007; 22(1): 49 - 59. [Abstract] [PDF]