Pre-hospital ECPR cost analysis and cost effectiveness modelling study

Background: The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined. Methods: Cost analyses of PH-ECPR was performed utilizing current PH-ECPR trial, NSW Ambulance Cardiac Arrest Registry (CAR), geospatial modelling and in-hospital costings data. Markov modelling was completed to combine the PH-ECPR cost analysis with reported patient outcomes across multiple ECPR strategies. Bridging formulae from ECPR survivor cerebral performance category (CPC) scores were used to estimate cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs). Probabilistic Sensitivity Analysis was completed to assess the probability of cost effectiveness for base case and PH-ECPR strategy variations. Results: Assuming a base case of 100 patients per year, with a 25% team allocation to ECPR, the average pre-hospital ECPR cost per patient was $12,741 and total of $88,656 AUD equating to approximately $44,000 per QALY. Addition of a conservative 10% kidney organ donation rate reduces the cost per QALY to $22,000. Patient survival rate, the proportion of time the pre-hospital ECPR team are allocated to ECPR and organ donation significantly impact PH-ECPR cost effectiveness. Conclusion: Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness.