Cost-effectiveness of the timing of respiratory extracorporeal membrane oxygenation initiation in pediatric patients.

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.