Direct hospital costs of extracorporeal life support therapy.An exploratory study of direct hospital costs of adult patients admitted to the Intensive Care Unit in the University Medical Center Groningen.

Hengel, B. van den (Berber) (2014) Direct hospital costs of extracorporeal life support therapy.An exploratory study of direct hospital costs of adult patients admitted to the Intensive Care Unit in the University Medical Center Groningen. thesis, Medicine.

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Abstract

Introduction: Extracorporeal life support (ECLS) by means of an extracorporeal membrane oxygenation (ECMO) is a technique that involves oxygenation of blood outside the body, and provides support to selected patients with severe respiratory or cardiac failure. Evidence for the use of ECLS therapy mainly is provided by observational studies. The only randomized trial thus far showed a positive, but modest effect on quality-adjusted life expectancy. At the same time, recent developments show that ECLS therapy is increasingly being used in more patients as well in more complex patients. Growing concerns over rising health care costs require careful evaluation of the cost-effectiveness of different therapies. This exploratory cost study is the first step towards an economic evaluation to assess cost-effectiveness of ECLS therapy for the different indications. Aims: The primary aim is to conduct a first exploration of the direct hospital costs of ECLS therapy in the Netherlands from a hospital perspective. The secondary aim is to provide an overview of the population who underwent ECLS therapy in the University Medical Center Groningen (UMCG) in Groningen, the Netherlands. Methods: In this single-center retrospective observational cohort study and exploratory cost study, we examined the patient medical records of the 72 consecutive patients who were admitted to the Intensive Care Unit (ICU) of the UMCG in the period from 2010 to 2013, and received ECLS therapy. Medical costs were estimated by multiplying registered healthcare consumption with unit prices. Unit prices were largely based on Dutch standard prices or own unit price calculations and were indexed to 2013 using consumer price indices. The direct costs of ECLS therapy as provided in the UMCG were assessed in detail. Results: The mean total hospital cost was €109.407,- (SD €94.273,-) per patient with a median of €86.753 (IQR €45.992 - €160.093). The mean total hospital costs ranges from €51.997 to €155.314, depending on the type and indication of ECLS. The mean direct ECLS costs were €11.948. On average, 52% of the total costs arose from hospital nursing days and 11% of direct ECLS costs. Surgery and diagnostics account for a vast amount of the remaining costs. Survival to discharge or transfer was 50% when the indication for ECLS was respiratory, 25% for a cardiac indication, and 14% for ECPR. Conclusion: This largest economic evaluation of direct hospital costs of ECLS therapy in the Netherlands performed so far, is a good starting point for further investigation of the cost-effectiveness of ECLS therapy. Then, interpretation of the total hospital costs in context to the outcome of ECLS patients is possible.

Item Type:	Thesis (Thesis)
Supervisor name:	Bergh, Dr. W.M. van den and Oude Lansink, Drs. A.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:06
Last Modified:	25 Jun 2020 11:06
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2597

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