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Cited by 121Mechanical Circulatory Support DevicesHealth Systems, Economic Evaluations, Quality of LifeRespiratory Support and Mechanisms

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US and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review

Harvey, Michael J., Gaies, Michael G., Prosser, Lisa A.·2015·Applied Health Economics and Health Policy
DOI 10.1007/s40258-015-0170-9
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Abstract

Context The in-hospital costs of extracorporeal membrane oxygenation (ECMO) have not been well established. Objective To evaluate the in-hospital costs of ECMO technology in both US and non-US settings for all patient types. Data sources Systematic review of English-language articles, using the PubMed, Embase, Web of Science and EconLit databases. Searches consisted of the terms 'ECMO' AND 'health expenditures' or 'resource use' or 'costs' or 'cost analysis' or 'cost(-)effectiveness' or 'cost(-)benefit' or 'cost(-)utility' or 'economic(-)evaluation' or 'economic' or 'QALY' or 'cost per quality-adjusted life year'. Study selection Only full scientific research articles were included. The exclusion criteria included papers that focused on pumpless ECMO, simulation training or decision support systems; papers that did not include human subjects or were not written in English; papers that did not mention ECMO, costs, economics or resource utilization; and papers that included only outside-hospital, infrastructure capital or device capital costs. Data extraction Data extraction was completed by one author, using predefined criteria. Results From the database searches, 1371 results were returned, 226 records underwent a full review and 18 studies were included in the final review. Three papers studied adult populations, two studied adult and paediatric populations, five studied only paediatric populations, one studied a paediatric and neonatal population, and the remaining seven exclusively examined ECMO in neonatal populations. The sample sizes ranged from 8 to 8753 patients. ECMO for respiratory conditions was the most common diagnosis category, followed by congenital diaphragmatic hernia (CDH) and then cardiac conditions. Most papers (n = 14) used retrospective cost collection. Only eight papers stated the perspective of the cost analysis. The results show a large variation in the cost of ECMO over multiple cost categories (e.g., range of total in-hospital costs of treatment: USD 42,554-537,554 [in 2013 values]). In the U.S.A., the reported costs of ECMO were highest for CDH repair, followed by cardiac conditions, and lowest for respiratory conditions. The US charges were highest for cardiac conditions. Outside the U.S.A., the ECMO cost was highest for cardiac conditions, followed by respiratory conditions, and lowest for CDH repair. No non-US studies reported charges. Conclusion The current literature shows that a large variation exists in the in-hospital cost estimates for ECMO. Further research is needed to understand how the diagnosis, setting and other factors relate to this variation in the cost of this technology. Reliable costing methodologies and cost information will be critical to inform policymakers and stakeholders wishing to maximize the value of advanced medical technologies such as ECMO.

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  • ECMO initiation requires precise timing within a narrow therapeutic window, and complications such as bleeding, thrombosis, and infection remain common.

    “Nonetheless, ECMO presents major challenges: initiation requires precise timing within a narrow therapeutic window, and complications such as bleeding, thrombosis, and infection remain common7,8.”

    From Decisional conflict among Chinese family caregivers prior to ECMO initiation: a cross-sectional study (2025) · cites this paper as [7]

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Metadata

Authors
Harvey, M. J., Gaies, M. G., & Prosser, L. A.
Affiliations
University of Michigan (US)
Corresponding author
Harvey, Michael J.
ORCID
Gaies, Michael G.
Venue
Applied Health Economics and Health Policy
Publisher
Springer Science and Business Media LLC
Published
2015-04-18
Volume
13
Issue
4
Pages
341-357
ISSN
  • 1175-5652 (ISSN-L)
  • 1179-1896
DOI
10.1007/s40258-015-0170-9
OpenAlex
W2092197685
Cited by
121
References
1
Citations by year
2026: 1 · 2025: 7 · 2024: 3 · 2023: 8 · 2022: 16 · 2021: 16 · 2020: 36 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 6 · 2015: 3
FWCI
0.67
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Applied Health Economics and Health Policy (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
extracorporeal membrane oxygenation, hospital costs, health care costs, cost analysis, congenital diaphragmatic hernia, neonatal ECMO, cost-effectiveness, cost per quality-adjusted life year, international cost comparison, resource utilization (health care), cost perspective
MeSH terms
Adult, Child, Cost-Benefit Analysis, Cross-Cultural Comparison, Humans, Infant, United States, Extracorporeal Membrane Oxygenation, Databases, Bibliographic, Hospital Costs, Quality-Adjusted Life Years, Internationality

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