Objective

The use of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrests (OHCA) has increased dramatically over the past decade. ECPR is resource intensive and costly, presenting challenges for policymakers. We sought to review the cost-effectiveness of ECPR compared with conventional cardiopulmonary resuscitation (CCPR) in OHCA.

Methods

We searched Medline, Embase, Tufts CEA registry and NHS EED databases from database inception to 2021 or 2015 for NHS EED. Cochrane Covidence was used to screen and assess studies. Data on costs, effects and cost-effectiveness of included studies were extracted by two independent reviewers. Costs were converted to USD using purchasing power parities (OECD, 2022).¹ The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist (Husereau et al., 2022)² was used for reporting quality and completeness of cost-effectiveness studies; the review was registered on PROSPERO, and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Four studies met the inclusion criteria; three cost-effectiveness studies reported an incremental cost-effectiveness ratio (ICER) for OHCA compared with conventional care, and one reported the mean operating cost of ECPR. ECPR was more costly, accrued more life years (LY) and quality-adjusted life years (QALYs) than CCPR and was more cost-effective when compared with CCPR and other standard therapies. Overall study quality was rated as moderate.

Conclusion

Few studies have examined the cost-effectiveness of ECPR for OHCA. Of those, ECPR for OHCA was cost-effective. Further studies are required to validate findings and assess the cost-effectiveness of establishing a new ECPR service or alternate ECPR delivery models.

中文翻译：

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成人院外心脏骤停体外心肺复苏的成本效益：系统评价

客观的

在过去十年中，体外心肺复苏术 (ECPR) 用于院外心脏骤停 (OHCA) 的情况急剧增加。ECPR 是资源密集型和成本高昂的，给政策制定者带来了挑战。我们试图在 OHCA 中评估 ECPR 与传统心肺复苏 (CCPR) 相比的成本效益。

方法

从数据库开始到 2021 年或 2015 年，我们搜索了 Medline、Embase、Tufts CEA 注册和 NHS EED 数据库以查找 NHS EED。Cochrane Covidence 用于筛选和评估研究。纳入研究的成本、效果和成本效益数据由两名独立评审员提取。使用购买力平价将成本转换为美元（经合组织，2022 年）。¹综合健康经济评估报告标准 (CHEERS) 清单（Husereau 等人，2022 年）²用于报告成本效益研究的质量和完整性；该评价已在 PROSPERO 上注册，并根据系统评价和元分析的首选报告项目 (PRISMA) 指南进行报告。

结果

四项研究符合纳入标准；三项成本效益研究报告了 OHCA 与传统护理相比的增量成本效益比 (ICER)，一项报告了 ECPR 的平均运营成本。与 CCPR 相比，ECPR 成本更高，累积更多生命年 (LY) 和质量调整生命年 (QALY)，并且与 CCPR 和其他标准疗法相比更具成本效益。总体研究质量被评为中等。

结论

很少有研究检查 ECPR 对 OHCA 的成本效益。其中，用于 OHCA 的 ECPR 具有成本效益。需要进一步的研究来验证结果并评估建立新的 ECPR 服务或替代 ECPR 交付模型的成本效益。