Amani Alenazi, Bashayr Alotaibi, Jason Madan, Joyce Yeung, Samantha Johnson, Keith Couper
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引用次数: 0
Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory cardiac arrest across the world, but its cost-effectiveness remains uncertain. We conducted this systematic review to assess the available date on the cost-effectiveness of ECPR compared with the standard care in patients with cardiac arrest.
Methods: We searched MEDLINE ALL (Ovid), EMBASE (Ovid), the Tufts Cost-Effectiveness Analysis (CEA) registry, and the Web of Science databases from database inception to 3rd February 2025 for all economic evaluations that reported the cost-effectiveness of ECPR for refractory cardiac arrest in adults. We undertook backward and forward citation tracking to identify any additional relevant articles. We used the Evers checklist, Philips checklist, and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist to assess the quality of the included study and the completeness of reporting. All reported costs were translated into 2025 US dollars (US$) to aid comparability.
Results: We included 15 studies. Of these, 12 (80 %) reported a high probability of ECPR being cost-effective, 1 (7 %) reported a low probability, 1 (7 %) suggested ECPR was potentially cost-effective, and 1 (7 %) concluded no probability of cost-effectiveness. Notably, the latter study specifically evaluated ECPR in patients with acute aortic dissection. The adjusted incremental cost-effectiveness ratios (ICERs) ranged from $2,564 to $276,307. When using these ICERs, ECPR remained cost-effective in 10 studies using the US willingness to pay threshold ($150,000), and in 7 studies using alternative thresholds ($40,000).
Conclusion: ECPR may be cost-effective in some settings, but there is marked variability in the reported cost-effectiveness of ECPR across current studies. This reflects differences in methodology, survival assumptions, and willingness to pay thresholds. Economic evaluation for appropriate implementation of ECPR across various healthcare settings remains heterogenous, highlighting the imminent need for standardised reporting in this domain.
背景：体外心肺复苏（ECPR）在世界范围内越来越多地用于难治性心脏骤停，但其成本效益仍不确定。我们进行了这项系统综述，以评估与心脏骤停患者的标准护理相比，ECPR的成本效益的可用数据。方法：我们检索MEDLINE ALL （Ovid）、EMBASE （Ovid）、Tufts成本效益分析（CEA）注册表和Web of Science数据库，从数据库建立到2025年2月3日，检索所有报告ECPR治疗成人难治性心脏骤停的成本效益的经济评估。我们进行了前后引文跟踪，以确定任何额外的相关文章。我们使用Evers检查表、Philips检查表和综合健康经济评估报告标准（CHEERS）检查表来评估纳入研究的质量和报告的完整性。所有报告的费用都换算成2025美元，以促进可比性。结果：我们纳入了15项研究。其中，12人（80%）报告ECPR具有成本效益的可能性高，1人（7%）报告可能性低，1人（7%）认为ECPR具有潜在的成本效益，1人（7%）认为没有成本效益的可能性。值得注意的是，后一项研究专门评估了急性主动脉夹层患者的ECPR。调整后的增量成本效益比率从2 564美元到276 307美元不等。在使用这些ICERs时，使用美国意愿支付阈值（15万美元）的10项研究和使用替代阈值（4万美元）的7项研究中，ECPR仍然具有成本效益。结论：ECPR在某些情况下可能具有成本效益，但在目前的研究中，ECPR报告的成本效益存在显著差异。这反映了方法、生存假设和支付意愿阈值的差异。在各种医疗保健环境中适当实施ECPR的经济评估仍然各不相同，这突出表明迫切需要在这一领域进行标准化报告。评审注册：PROSPERO （CRD42024582408）。
期刊介绍：
Resuscitation is a monthly international and interdisciplinary medical journal. The papers published deal with the aetiology, pathophysiology and prevention of cardiac arrest, resuscitation training, clinical resuscitation, and experimental resuscitation research, although papers relating to animal studies will be published only if they are of exceptional interest and related directly to clinical cardiopulmonary resuscitation. Papers relating to trauma are published occasionally but the majority of these concern traumatic cardiac arrest.
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