PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1640-1649 (doi:10.1542/peds.2005-1150)
Cost-Effectiveness of Neonatal Extracorporeal Membrane Oxygenation Based on 7-Year Results From the United Kingdom Collaborative ECMO Trial
a National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
b Neonatal Unit, John Radcliffe Hospital, Oxford, United Kingdom
c Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
d Neonatal Unit, Leicester Royal Infirmary, Leicester, United Kingdom
e Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
OBJECTIVE. To assess the long-term cost-effectiveness of extracorporeal membrane oxygenation (ECMO) for mature newborn infants with severe respiratory failure.
METHODS. A prospective economic evaluation was conducted alongside a pragmatic randomized, controlled trial in which 185 infants were randomly allocated to ECMO (n = 93) or conventional management (n = 92) and then followed up to 7 years of age. Information about their use of health services during the follow-up period was combined with unit costs (£, 2002–2003 prices) to obtain a net cost per child. The cost-effectiveness of neonatal ECMO was expressed in terms of incremental cost per additional life year gained and incremental cost per additional disability-free life year gained. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness-to-pay thresholds held by decision-makers for an additional life year and for an additional disability-free life year.
RESULTS. Over 7 years, neonatal ECMO was effective at reducing known death or severe disability. Mean health service costs during the first 7 years of life were £30270 in the ECMO group and £10229 in the conventional management group, generating a mean cost difference of £20041 that was statistically significant. The incremental cost per life year gained was estimated at £13385. The incremental cost per disability-free life year gained was estimated at £23566. At the notional willingness-to-pay threshold of £30000 for an additional life year, the probability that neonatal ECMO is cost-effective at 7 years was estimated at 0.98. This translated into a mean net benefit of £24362 for each adoption of neonatal ECMO rather than conventional management.
CONCLUSIONS. This study provides rigorous evidence of the cost-effectiveness of neonatal ECMO during childhood.
Key Words: ECMO • costs • cost-effectiveness
Abbreviations: ECMO—extracorporeal membrane oxygenation • NHS—National Health Service • CI—confidence interval • QALY—quality-adjusted life year
Accepted Oct 13, 2005.
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