Economic evaluation and randomised controlled trial of extracorporeal membrane oxygenation: UK collaborative trial

BMJ 1998;317:911-916 ( 3 October )

Papers

Tracy E Roberts, lecturer in health economics, the Extracorporeal Membrane Oxygenation Economics Working Group on behalf of the Extracorporeal Membrane Oxygenation Trial Steering Group.

Health Economics Facility, University of Birmingham, Birmingham B15 2RT

robertte{at}hsmc.bham.ac.uk

Objective: To compare the resource implications and short term outcomes of extracorporeal membrane oxygenation andconventional management for term babies with severe respiratory failure.
Design: Cost effectiveness evaluation alongside a randomised controlledtrial.
Setting: 55 approved recruiting hospitals in the United Kingdom. These hospitals provided conventional management,but infants randomised to extracorporeal membrane oxygenationwere transferred to one of five specialistcentres.
Subjects: 185 mature newborn infants (gestational age at birth >35 weeks, birth weight >2 kg) with severe respiratoryfailure (oxygenation index >40) recruited between 1993 and 1995.The commonest diagnoses were persistent pulmonary hypertensiondue to meconium aspiration, congenital diaphragmatic hernia, isolatedpersistent fetal circulation, sepsis, and idiopathic respiratorydistresssyndrome.
Main outcome measure: Cost effectiveness based on survival at 1 year of age without severedisability.
Results: 63 (68%) of the 93 infants randomised to extracorporeal membrane oxygenation survived to 1 year compared with38 (41%) of the 92 infants who received conventional management.Of those that survived, one infant in each arm was lost to followup and the proportion with disability at 1 year was similar inthe two arms of the trial. One child in each arm had severe disability.The estimated additional cost of extracorporeal membrane oxygenationper additional surviving infant without severe disability was£51 222 and the cost per surviving infant with no disability was£75 327.
Conclusions: Extracorporeal membrane oxygenation for term neonates with severe respiratory failure would increase overallsurvival without disability. Although the policy will increasecosts of neonatal health care, it is likely to be as cost effectiveas other life extendingtechnologies.

Key messages

Extracorporeal membrane oxygenation increases survival for term neonates in respiratory failure
The technique was three times more costly than conventional management
If extracorporeal membrane oxygenation is adopted it will increase the cost of neonatal health care.
Extracorporeal membrane oxygenation may be as cost effective as other life extending technologies, but long term follow up studies are needed to confirm this

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