Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2026
Cost-effectiveness of the timing of respiratory extracorporeal membrane oxygenation initiation in pediatric patients.
СтатьяНазвание и аннотация: Перевод в очереди
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Camelo-Pardo Gianmarco, Mendoza-Monsalve Alejandra, Licht-Ardila Maricel, Ortiz-Córdoba Angélica Lucero, Almarales-Navarro José Rafael, Hurtado-Ortiz Alexandra, Bermon Anderson, Marique-Hernández Edgar Fabián
Аннотация
OBJECTIVE: The aim of this study was to assess the cost-effectiveness of early versus late initiation of extracorporeal membrane oxygenation (ECMO) in pediatric patients with acute respiratory distress syndrome admitted to the intensive care unit.
METHODS: A cost-effectiveness analysis was conducted from the hospital provider perspective, comparing early (≤7 days) versus late (>7 days) initiation of ECMO. Direct medical costs and 90-day survival were incorporated into a decision tree to estimate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were performed using a willingness-to-pay threshold equivalent to three times the Colombian gross domestic product per capita.
RESULTS: Among 78 patients, most patients received early ECMO initiation, and this strategy was associated with similar mortality and comparable total direct medical costs compared with late initiation. Probabilistic simulations indicated a higher probability of cost-effectiveness for early initiation across different willingness-to-pay thresholds. Cost parameters were the main drivers of variability in the incremental cost-effectiveness ratio.
CONCLUSIONS: No statistically significant differences were observed between early and late ECMO initiation in survival or costs. A possible economic trend favoring early initiation should be interpreted cautiously, given limited statistical power.
METHODS: A cost-effectiveness analysis was conducted from the hospital provider perspective, comparing early (≤7 days) versus late (>7 days) initiation of ECMO. Direct medical costs and 90-day survival were incorporated into a decision tree to estimate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were performed using a willingness-to-pay threshold equivalent to three times the Colombian gross domestic product per capita.
RESULTS: Among 78 patients, most patients received early ECMO initiation, and this strategy was associated with similar mortality and comparable total direct medical costs compared with late initiation. Probabilistic simulations indicated a higher probability of cost-effectiveness for early initiation across different willingness-to-pay thresholds. Cost parameters were the main drivers of variability in the incremental cost-effectiveness ratio.
CONCLUSIONS: No statistically significant differences were observed between early and late ECMO initiation in survival or costs. A possible economic trend favoring early initiation should be interpreted cautiously, given limited statistical power.