TY - JOUR
T1 - Cost-effectiveness of extracorporeal CPR for out-of-hospital cardiac arrest
T2 - a trial-based Markov-model with a lifetime horizon
AU - van de Koolwijk, Anina F
AU - Gabrio, Andrea
AU - Delnoij, Thijs S R
AU - Suverein, Martje M
AU - Eussen, Stijn E D M
AU - Essers, Brigitte A B
AU - Oude Lansink-Hartgring, Annemieke
AU - Hermanides, Renicus C
AU - Otterspoor, Luuk C
AU - Elzo Kraemer, Carlos V
AU - Vlaar, Alexander P J
AU - van der Heijden, Joris J
AU - Scholten, Erik
AU - den Uil, Corstiaan A
AU - Dos Reis Miranda, Dinis
AU - Akin, Sakir
AU - de Metz, Jesse
AU - van der Horst, Iwan C C
AU - Maessen, Jos G
AU - Lorusso, Roberto
AU - van de Poll, Marcel C G
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
PY - 2026/7
Y1 - 2026/7
N2 - Aims: Extracorporeal cardiopulmonary resuscitation (ECPR) can restore circulation in refractory out-of-hospital cardiac arrest (OHCA). A trial-based analysis with a 1-year horizon showed limited cost-effectiveness of this demanding procedure. However, arguably, long-term incremental health benefits may justify high initial incremental costs. We assessed the cost-effectiveness of ECPR compared with conventional cardiopulmonary resuscitation (CCPR) for OHCA with a lifetime horizon using trial-based data. Methods: Healthcare and societal costs and quality adjusted life years (QALY), assessed using EQ-5D-5L, were simulated over a 20-year period following ECPR or CCPR for OHCA using a Markov model. Data from the per-protocol population of a multicentre randomized controlled trial comparing ECPR with CCPR were used as input parameters. The incremental cost-effectiveness ratio (ICER) was expressed as Euros per QALY. Probabilistic and deterministic sensitivity analyses were performed. Results: We used data from 33 ECPR and 47 CCPR patients. Mean ± SD costs after 1 year were €26.372 ± 28.237 vs. €10.356 ± 37.706, and survival was 15% vs. 9% in patients treated with ECPR vs. CCPR. Over a lifetime horizon, mean incremental costs and QALYs of ECPR were €160.969 and 0.66, respectively, resulting in an ICER of €242.122/QALY. At a willingness-to-pay threshold of €80.000 per QALY gained, the probability of ECPR being cost-effective was 46%. The costs of non-survivors in both arms and the QALYs gained were the major drivers of the ICER. Conclusion: Extracorporeal cardiopulmonary resuscitation for refractory OHCA has a low probability of being cost-effective. To enhance cost-effectiveness, improving ECPR effectiveness and reducing hospital costs of ECPR non-survivors are mandatory.
AB - Aims: Extracorporeal cardiopulmonary resuscitation (ECPR) can restore circulation in refractory out-of-hospital cardiac arrest (OHCA). A trial-based analysis with a 1-year horizon showed limited cost-effectiveness of this demanding procedure. However, arguably, long-term incremental health benefits may justify high initial incremental costs. We assessed the cost-effectiveness of ECPR compared with conventional cardiopulmonary resuscitation (CCPR) for OHCA with a lifetime horizon using trial-based data. Methods: Healthcare and societal costs and quality adjusted life years (QALY), assessed using EQ-5D-5L, were simulated over a 20-year period following ECPR or CCPR for OHCA using a Markov model. Data from the per-protocol population of a multicentre randomized controlled trial comparing ECPR with CCPR were used as input parameters. The incremental cost-effectiveness ratio (ICER) was expressed as Euros per QALY. Probabilistic and deterministic sensitivity analyses were performed. Results: We used data from 33 ECPR and 47 CCPR patients. Mean ± SD costs after 1 year were €26.372 ± 28.237 vs. €10.356 ± 37.706, and survival was 15% vs. 9% in patients treated with ECPR vs. CCPR. Over a lifetime horizon, mean incremental costs and QALYs of ECPR were €160.969 and 0.66, respectively, resulting in an ICER of €242.122/QALY. At a willingness-to-pay threshold of €80.000 per QALY gained, the probability of ECPR being cost-effective was 46%. The costs of non-survivors in both arms and the QALYs gained were the major drivers of the ICER. Conclusion: Extracorporeal cardiopulmonary resuscitation for refractory OHCA has a low probability of being cost-effective. To enhance cost-effectiveness, improving ECPR effectiveness and reducing hospital costs of ECPR non-survivors are mandatory.
U2 - 10.1093/ehjacc/zuag058
DO - 10.1093/ehjacc/zuag058
M3 - Article
C2 - 41990351
SN - 2048-8726
VL - 15
SP - 516
EP - 523
JO - European heart journal. Acute cardiovascular care
JF - European heart journal. Acute cardiovascular care
IS - 7
ER -