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Economic evaluation and randomised controlled trial of extracorporeal membrane oxygenation: UK collaborative trialCommentary: Concurrent economic evaluations are rare but should be standard practice

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7163.911 (Published 03 October 1998) Cite this as: BMJ 1998;317:911

Abstract

Objective: To compare the resource implications and short term outcomes of extracorporeal membrane oxygenation and conventional management for term babies with severe respiratory failure.

Design: Cost effectiveness evaluation alongside a randomised controlled trial.

Setting: 55 approved recruiting hospitals in the United Kingdom. These hospitals provided conventional management, but infants randomised to extracorporeal membrane oxygenation were transferred to one of five specialist centres.

Subjects: 185 mature newborn infants (gestational age at birth >35 weeks, birth weight >2 kg) with severe respiratory failure (oxygenation index >40) recruited between 1993 and 1995. The commonest diagnoses were persistent pulmonary hypertension due to meconium aspiration, congenital diaphragmatic hernia, isolated persistent fetal circulation, sepsis, and idiopathic respiratory distress syndrome.

Main outcome measure: Cost effectiveness based on survival at 1 year of age without severe disability.

Results: 63 (68%) of the 93 infants randomised to extracorporeal membrane oxygenation survived to 1 year compared with 38 (41%) of the 92 infants who received conventional management. Of those that survived, one infant in each arm was lost to follow up and the proportion with disability at 1 year was similar in the two arms of the trial. One child in each arm had severe disability. The estimated additional cost of extracorporeal membrane oxygenation per 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 overall survival without disability. Although the policy will increase costs of neonatal health care, it is likely to be as cost effective as other life extending technologies.

Footnotes

    • Accepted 16 June 1998

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

    1. Tracy E Roberts, lecturer in health economics (robertte{at}hsmc.bham.ac.uk)
    2. the Extracorporeal Membrane Oxygenation Economics Working Group on behalf of the Extracorporeal Membrane Oxygenation Trial Steering Group
    1. Health Economics Facility, University of Birmingham, Birmingham B15 2RT
    2. Royal Defence Medical College and Ministry of Defence, Ash Vale, Hants GU12 5RR
    • Accepted 16 June 1998

    Abstract

    Objective: To compare the resource implications and short term outcomes of extracorporeal membrane oxygenation and conventional management for term babies with severe respiratory failure.

    Design: Cost effectiveness evaluation alongside a randomised controlled trial.

    Setting: 55 approved recruiting hospitals in the United Kingdom. These hospitals provided conventional management, but infants randomised to extracorporeal membrane oxygenation were transferred to one of five specialist centres.

    Subjects: 185 mature newborn infants (gestational age at birth >35 weeks, birth weight >2 kg) with severe respiratory failure (oxygenation index >40) recruited between 1993 and 1995. The commonest diagnoses were persistent pulmonary hypertension due to meconium aspiration, congenital diaphragmatic hernia, isolated persistent fetal circulation, sepsis, and idiopathic respiratory distress syndrome.

    Main outcome measure: Cost effectiveness based on survival at 1 year of age without severe disability.

    Results: 63 (68%) of the 93 infants randomised to extracorporeal membrane oxygenation survived to 1 year compared with 38 (41%) of the 92 infants who received conventional management. Of those that survived, one infant in each arm was lost to follow up and the proportion with disability at 1 year was similar in the two arms of the trial. One child in each arm had severe disability. The estimated additional cost of extracorporeal membrane oxygenation per 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 overall survival without disability. Although the policy will increase costs of neonatal health care, it is likely to be as cost effective as other life extending technologies.

    Footnotes

    • Funding Funding: England and Wales Department of Health, Chief Scientist's Office, and Scottish Office Department of Health.

    • Conflict of interest None

    • Accepted 16 June 1998

    Commentary: Concurrent economic evaluations are rare but should be standard practice

    1. Tom Jefferson, Edmund Parkes professor of preventive medicine (Zorria{at}epinet.co.uk)
    1. Health Economics Facility, University of Birmingham, Birmingham B15 2RT
    2. Royal Defence Medical College and Ministry of Defence, Ash Vale, Hants GU12 5RR
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