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Rev Bras Ter Intensiva. 2014 Jul-Sep;26(3):253-62.

The economic effect of extracorporeal membrane oxygenation to support adults with severe respiratory failure in Brazil: a hypothetical analysis.

[Article in English, Portuguese]

Collaborators (127)

Hirota AS, Maciel AT, Carvalho CR, Machtans CC, Costa EL, Barbosa EV, da Silva EM, Schettino GP, Taniguchi LU, Azevedo LC, Amato MB, Park M, Tucci M, de Nardi Ignácio M, Mendes PV, Nardi RO, Romano TG, Alves Neves W, Colombo AS, Cavalcanti AB, de Carvalho AG, Réa-Neto Á, Martinez A, de Oliveira AM, Japiassu A, Nunes AL, Torelly AP, Nogueira AC, Pereira AJ, Junior AP, Martins Bdo C, Caser B, Gomes BC, Mazza BF, Barboza CE, Righy C, Teixeira C, Eliana CP, Moreira CL, Ritter C, Damiani CT, Amendola CP, de Souza Barros D, Aragão D, Ribeiro Dda C, Cristovao D, Mannarino D, Dalcomune DM, Moraes E, Ferreira E, Silva E, Lopes EA, Rego Ê, Suzumura ÉA, Pacheco ED, Giannini FP, Dal-Pizzol F, Saddy F, Fernandes FE, Rodriguez FB, Machado FR, Soriano F, Carvalho FB, Schettino G, de Oliveira GA, de Melo HK, Salluh J, Neto JA, dos Anjos JC, Maccari JG, Fernandes JB, Ferreira JC, de Almeida JP, Meira KL, de Assis Simões L, Nunes LB, Tanaka L, Leal L, Reis LM, Gondim LA, Tannous L, Oliveira L, Sanches LC, Azevedo LC, Hajjar L, Malbouisson LM, Osório LA, Neto ML, de Oliveira Maia M, Lugarinho ME, Romano ML, Park M, Soares M, Knibel MF, Tavares ME, Kehdi MG, Ponte M, de Oliveira MC, Assunção MS, Gusman PB, Schwarz P, Berto P, Luciano PM, Tierno PF, Caruso P, de Azambuja Rodrigues PM, Varaschin P, Abelha P, Castro PS, Morsch RD, Campos RS, Costa RT, Nóbrega RS, Carbonell RC, Espinoza R, dos Santos RB, Almeida RD, de Oliveira RP, Alves RA, Filho RC, Moulin S, Silva SA, Castellões TF, Lisboa T, Silva UV, Rezende VM, de Souza Dantas VC.

Author information

1
Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil.
2
Unidade de Terapia Intensiva, Hospital Sírio Libanês, São Paulo, SP, Brasil.
3
Pontifícia Universidade Católica de Campinas, Campinas, SP, Brasil.
4
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

Abstract

OBJECTIVE:

To analyze the cost-utility of using extracorporeal oxygenation for patients with severe acute respiratory distress syndrome in Brazil.

METHODS:

A decision tree was constructed using databases from previously published studies. Costs were taken from the average price paid by the Brazilian Unified Health System (Sistema Único de Saúde; SUS) over three months in 2011. Using the data of 10,000,000 simulated patients with predetermined outcomes and costs, an analysis was performed of the ratio between cost increase and years of life gained, adjusted for quality (cost-utility), with survival rates of 40 and 60% for patients using extracorporeal membrane oxygenation.

RESULTS:

The decision tree resulted in 16 outcomes with different life support techniques. With survival rates of 40 and 60%, respectively, the increased costs were R$=-301.00/-14.00, with a cost of R$=-30,913.00/-1,752.00 paid per six-month quality-adjusted life-year gained and R$=-2,386.00/-90.00 per quality-adjusted life-year gained until the end of life, when all patients with severe ARDS were analyzed. Analyzing only patients with severe hypoxemia (i.e., a ratio of partial oxygen pressure in the blood to the fraction of inspired oxygen <100 mmHg), the increased cost was R$=-5,714.00/272.00, with a cost per six-month quality-adjusted life-year gained of R$=-9,521.00/293.00 and a cost of R$=-280.00/7.00 per quality-adjusted life-year gained.

CONCLUSION:

The cost-utility ratio associated with the use of extracorporeal membrane oxygenation in Brazil is potentially acceptable according to this hypothetical study.

PMID:
25295819
PMCID:
PMC4188461
[Indexed for MEDLINE]
Free PMC Article

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