Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1640-1649 (doi:10.1542/peds.2005-1150)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (8)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Petrou, S.
Right arrow Articles by McNally, H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Petrou, S.
Right arrow Articles by McNally, H.
Related Collections
Right arrow Premature & Newborn

Cost-Effectiveness of Neonatal Extracorporeal Membrane Oxygenation Based on 7-Year Results From the United Kingdom Collaborative ECMO Trial

Stavros Petrou, PhDa, Matthias Bischof, MPharma, Charlotte Bennett, MD FRCPCHb, Diana Elbourne, PhDc, David Field, DMd and Helena McNally, MSce

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.




This article has been cited by other articles:


Home page
 ChestHome page
D. J. E. Schuerer, N. S. Kolovos, K. V. Boyd, and C. M. Coopersmith
Extracorporeal Membrane Oxygenation: Current Clinical Practice, Coding, and Reimbursement
Chest, July 1, 2008; 134(1): 179 - 184.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. Wagner, I. Risnes, T. Berntsen, A.-B. Skarbo, B. Ramberg, I. H. Vandvik, M. Rasmussen, T. Nome, K. B. Olsen, and J. L. Svennevig
Clinical and Psychosocial Follow-Up Study of Children Treated With Extracorporeal Membrane Oxygenation
Ann. Thorac. Surg., October 1, 2007; 84(4): 1349 - 1355.
[Abstract] [Full Text] [PDF]

Home page
 JRSMHome page
K. Chalkidou, A. Hoy, and P. Littlejohns
Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research
J R Soc Med, October 1, 2007; 100(10): 453 - 460.
[Full Text] [PDF]

Home page
 PediatricsHome page
C. S. Beardsmore, J. Westaway, H. Killer, R. K. Firmin, and H. Pandya
How Does the Changing Profile of Infants Who Are Referred for Extracorporeal Membrane Oxygenation Affect Their Overall Respiratory Outcome?
Pediatrics, October 1, 2007; 120(4): e762 - e768.
[Abstract] [Full Text] [PDF]