Abstract：
OBJECTIVE: When out-of-hospital cardiac arrest (OHCA) becomes refractory, extracorporeal cardiopulmonary resuscitation (ECPR) is a potential option to restore circulation and improve the patient\'s outcome. However, ECPR requires specific materials and highly skilled personnel, and it is unclear whether increased survival and health-related quality of life (HRQOL) justify these costs.
RESULTS: This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands. We analysed healthcare costs in the first year and measured HRQOL using the EQ-5D-5L at 1, 3, 6, and 12 months. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes, and acceptability curves were calculated. Sensitivity analyses were performed for per-protocol and as-treated subgroups as well as imputed productivity loss in deceased patients. In total, 132 patients were enrolled: 62 in the CCPR and 70 in the ECPR group. The difference in mean costs after 1 year was €5109 (95% confidence interval -7264 to 15 764). Mean quality-adjusted life year (QALY) after 1 year was 0.15 in the ECPR group and 0.11 in the CCPR group, resulting in an ICER of €121 643 per additional QALY gained. The acceptability curve shows that at a willingness-to-pay threshold of €80.000, the probability of ECPR being cost-effective compared with CCPR is 36%. Sensitivity analysis showed increasing ICER in the per-protocol and as-treated groups and lower probabilities of acceptance.
CONCLUSIONS: Hospital-based ECPR in refractory OHCA has a low probability of being cost-effective in a trial-based economic evaluation.
RESULTS: This cost-effectiveness study was part of the INCEPTION study, a multi-centre, pragmatic randomized trial comparing hospital-based ECPR to conventional CPR (CCPR) in patients with refractory OHCA in 10 cardiosurgical centres in the Netherlands. We analysed healthcare costs in the first year and measured HRQOL using the EQ-5D-5L at 1, 3, 6, and 12 months. Incremental cost-effectiveness ratios (ICERs), cost-effectiveness planes, and acceptability curves were calculated. Sensitivity analyses were performed for per-protocol and as-treated subgroups as well as imputed productivity loss in deceased patients. In total, 132 patients were enrolled: 62 in the CCPR and 70 in the ECPR group. The difference in mean costs after 1 year was €5109 (95% confidence interval -7264 to 15 764). Mean quality-adjusted life year (QALY) after 1 year was 0.15 in the ECPR group and 0.11 in the CCPR group, resulting in an ICER of €121 643 per additional QALY gained. The acceptability curve shows that at a willingness-to-pay threshold of €80.000, the probability of ECPR being cost-effective compared with CCPR is 36%. Sensitivity analysis showed increasing ICER in the per-protocol and as-treated groups and lower probabilities of acceptance.
CONCLUSIONS: Hospital-based ECPR in refractory OHCA has a low probability of being cost-effective in a trial-based economic evaluation.
摘要：
背景：当院外心脏骤停（OHCA）变得难治时，体外心肺复苏术（ECPR）是恢复血液循环和改善患者预后的潜在选择。然而,ECPR需要特定的材料和高技能的人员，尚不清楚生存率和健康相关生活质量(HRQOL)的提高是否证明这些费用是合理的.
方法：这项成本效益研究是INCEPTION研究的一部分，一个多中心，在荷兰10个心脏外科中心的难治性OHCA患者中比较医院ECPR和常规CPR(CCPR)的实用性随机试验.我们分析了第一年的医疗费用，并在1、3、6和12个月使用EQ-5D-5L测量了HRQOL。增量成本效益比(ICER)，成本效益飞机，并计算了可接受性曲线。对按方案和治疗的亚组以及死亡患者的估计生产力损失进行了敏感性分析。
结果：共纳入132例患者：CCPR组62例，ECPR组70例。一年后的平均成本差异为5,109欧元（95CI-7,264-15,764）。一年后，ECPR组的平均QALY为0.15，CCPR组为0.11，导致每增加QALY的ICER为121,643欧元。可接受性曲线表明，在80.000欧元的支付意愿阈值下，与CCPR相比，ECPR具有成本效益的可能性为36％。敏感性分析显示，符合方案和治疗组的ICER增加，接受概率较低。
结论：在以试验为基础的经济评估中，以医院为基础的ECPR在难治性OHCA中具有较低的成本效益的可能性。
方法：这项成本效益研究是INCEPTION研究的一部分，一个多中心，在荷兰10个心脏外科中心的难治性OHCA患者中比较医院ECPR和常规CPR(CCPR)的实用性随机试验.我们分析了第一年的医疗费用，并在1、3、6和12个月使用EQ-5D-5L测量了HRQOL。增量成本效益比(ICER)，成本效益飞机，并计算了可接受性曲线。对按方案和治疗的亚组以及死亡患者的估计生产力损失进行了敏感性分析。
结果：共纳入132例患者：CCPR组62例，ECPR组70例。一年后的平均成本差异为5,109欧元（95CI-7,264-15,764）。一年后，ECPR组的平均QALY为0.15，CCPR组为0.11，导致每增加QALY的ICER为121,643欧元。可接受性曲线表明，在80.000欧元的支付意愿阈值下，与CCPR相比，ECPR具有成本效益的可能性为36％。敏感性分析显示，符合方案和治疗组的ICER增加，接受概率较低。
结论：在以试验为基础的经济评估中，以医院为基础的ECPR在难治性OHCA中具有较低的成本效益的可能性。
