Economic Aspects of ECMO-Assisted Resuscitation (ECPR)

Objectives: VA ECMO is a technology used in many patients as a rescue therapy. It is generally considered an expensive technology. However, conventional treatment in these severely sick patients in cardiogenic shock or after successful resuscitation has its costs too. In order to shed light into this aspect, we evaluated as a first approach costs and reimbursement in patients after VA ECMO-assisted resuscitation (ECPR).

Methods: Costs and reimbursement of all our ECPR patients in 2018 were analyzed with the aid of the institutional ECMO database and the controlling administration. While, reimbursement was precisely determinable, only costs could be estimated.

Results: In 61 of 64 patients placed on VA ECMO under resuscitation in 2018, a complete data set was available. Survival to discharge was 25% (mean age: 57 ± 14 years, 70% male) with a median hospital stay of 5 days (range: 1–151 days including all patients). Patients who survived to discharge had a median stay on the ICU of 20 days (range: 7–33 days), and a total hospital stay of 23 days (range: 10–48 days). Median reimbursement was 29,872¢ (range: 7,356¢–457,000¢) leading to a total reimbursement of 3,016,644¢.

The implantation costs including material as well as human resources and 1 day on the ICU were calculated to 7,470¢. The following treatment days on ECMO were estimated with a total cost of 1,944¢/day including blood tests, echocardiography, human resources, and intensive care treatment. In sum a total ECMO treatment cost of 726,026¢ for the time period on ECMO was calculated. The calculated costs were approximately 20% higher than the DRG additional pecuniaries for ECMO therapy payed by the health care insurances. Surgical procedures of any kind (cardiac, vascular, abdominal surgery, etc.) were necessary in 29 patients (47%). The remaining time period without ECMO was not yet evaluated precisely, since these costs would be present in any patient post reanimation.

Conclusion: ECPR creates a new and supplemental patient population. In addition to the medical advantages of ECPR, this novel medical field may potentially be a source of income.

No conflict of interest has been declared by the author(s).