Cost-Utility of Venovenous Ecmo Associated with Protective Mechanical Ventilation in the Treatment of Patients with Acute Respiratory Distress Syndrome

Abstract

Introduction: with the emergence of COVID-19 in the world, there was a race against time in the search for studies and scientific information that validated the most appropriate treatment. As a result, when caring for patients with the disease who developed ARDS and progressed to a severe condition with hospitalization in the ICU, the need for scientific evidence to guide care for these patients was even greater. Speculation about the effectiveness of using ECMO for these patients began to emerge, and with it, the need for scientific studies that would show the costs and benefits of acquiring this technology in the SUS. The dissertation that is intended to be defended is whether the use of VV ECMO associated with protective mechanical ventilation in patients with ARDS is more cost-effective compared to exclusive protective mechanical ventilation. General Objective: to analyze the cost-effectiveness of veno-venous ECMO in the treatment of patients with COVID-19 who evolve with severe Acute Respiratory Failure. Specific Objectives: review the scientific literature to summarize the best scientific evidence available on the safety and efficacy of using exclusive mechanical ventilation and venovenous ECMO in patients with acute respiratory failure, and estimate the costs associated with mechanical ventilation and the use of veno-venous ECMO. Method: Rapid systematic review for a complete health economic assessment based on a Markov model to estimate the incremental cost-effectiveness of using venovenous ECMO associated with protective mechanical ventilation in the treatment of patients with ARDS due to COVID-19. Results: Based on the estimated costs in each of the base case scenarios and the probabilities of the clinical effects resulting from the interventions, the study showed that the ECMO + protective IMV intervention offers around 0.295 AAQA compared to 0.2015 AAQA offered by the exclusive protective VMI. The incremental cost of ECMO + protective IMV is BRL 12,519.94 for 0.397 effectiveness compared to 0.215 exclusive protective IMV (incremental effectiveness of 0.182). For each qualityadjusted year of life gained, the amount of R$ 68,902.92 would have to be disbursed. Conclusion: the results showed that both veno-venous ECMO associated with protective mechanical ventilation and exclusive protective mechanical ventilation can be cost-effective alternatives for the treatment of patients with ARDS due to COVID-19 in the SUS, depending on the willingness to pay. However, in terms of effectiveness, ECMO was the most effective alternative, but with the highest cost increase.