Maude St-Onge1, Eddy Fan2, Bruno Mégarbane3, Rebecca Hancock-Howard4, Peter C Coyte5. 1. University of Toronto, Toronto, Ontario, Canada; Ontario Poison Centre, Toronto, Ontario, Canada. Electronic address: egnomie@hotmail.com. 2. University of Toronto, Toronto, Ontario, Canada; Critical Care Medicine, Toronto General Hospital, Toronto, Ontario, Canada. Electronic address: eddy.fan@uhn.ca. 3. Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM U1144, Paris-Diderot University, Paris, France. Electronic address: bruno.megarbane@lrb.aphp.fr. 4. Health System Strategy and Policy Division, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada. Electronic address: rebecca.hancock-howard@ontario.ca. 5. University of Toronto, Toronto, Ontario, Canada; Health Economics at the Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada. Electronic address: peterccoyte@gmail.com.
Abstract
PURPOSE: Venoarterial extracorporeal membrane oxygenation represents an emerging and recommended option to treat life-threatening cardiotoxicant poisoning. The objective of this cost-effectiveness analysis was to estimate the incremental cost-effectiveness ratio of using venoarterial extracorporeal membrane oxygenation for adults in cardiotoxicant-induced shock or cardiac arrest compared with standard care. MATERIALS AND METHODS: Adults in shock or in cardiac arrest secondary to cardiotoxicant poisoning were studied with a lifetime horizon and a societal perspective. Venoarterial extracorporeal membrane oxygenation cost effectiveness was calculated using a decision analysis tree, with the effect of the intervention and the probabilities used in the model taken from an observational study representing the highest level of evidence available. The costs (2013 Canadian dollars, where $1.00 Canadian = $0.9562 US dollars) were documented with interviews, reviews of official provincial documents, or published articles. A series of one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were used to evaluate uncertainty in the decision model. RESULTS: The cost per life year (LY) gained in the extracorporeal membrane oxygenation group was $145 931/18 LY compared with $88 450/10 LY in the non-extracorporeal membrane oxygenation group. The incremental cost-effectiveness ratio ($7185/LY but $34 311/LY using a more pessimistic approach) was mainly influenced by the probability of survival. The probabilistic sensitivity analysis identified variability in both cost and effectiveness. CONCLUSION: Venoarterial extracorporeal membrane oxygenation may be cost effective in treating cardiotoxicant poisonings.
PURPOSE: Venoarterial extracorporeal membrane oxygenation represents an emerging and recommended option to treat life-threatening cardiotoxicant poisoning. The objective of this cost-effectiveness analysis was to estimate the incremental cost-effectiveness ratio of using venoarterial extracorporeal membrane oxygenation for adults in cardiotoxicant-induced shock or cardiac arrest compared with standard care. MATERIALS AND METHODS: Adults in shock or in cardiac arrest secondary to cardiotoxicant poisoning were studied with a lifetime horizon and a societal perspective. Venoarterial extracorporeal membrane oxygenation cost effectiveness was calculated using a decision analysis tree, with the effect of the intervention and the probabilities used in the model taken from an observational study representing the highest level of evidence available. The costs (2013 Canadian dollars, where $1.00 Canadian = $0.9562 US dollars) were documented with interviews, reviews of official provincial documents, or published articles. A series of one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were used to evaluate uncertainty in the decision model. RESULTS: The cost per life year (LY) gained in the extracorporeal membrane oxygenation group was $145 931/18 LY compared with $88 450/10 LY in the non-extracorporeal membrane oxygenation group. The incremental cost-effectiveness ratio ($7185/LY but $34 311/LY using a more pessimistic approach) was mainly influenced by the probability of survival. The probabilistic sensitivity analysis identified variability in both cost and effectiveness. CONCLUSION: Venoarterial extracorporeal membrane oxygenation may be cost effective in treating cardiotoxicant poisonings.
Authors: Adeel Abbasi; Cynthia Devers; Christopher S Muratore; Colin Harrington; Corey E Ventetuolo Journal: J Crit Care Date: 2017-10-18 Impact factor: 3.425
Authors: Maude St-Onge; Kurt Anseeuw; Frank Lee Cantrell; Ian C Gilchrist; Philippe Hantson; Benoit Bailey; Valéry Lavergne; Sophie Gosselin; William Kerns; Martin Laliberté; Eric J Lavonas; David N Juurlink; John Muscedere; Chen-Chang Yang; Tasnim Sinuff; Michael Rieder; Bruno Mégarbane Journal: Crit Care Med Date: 2017-03 Impact factor: 7.598
Authors: Spyros D Mentzelopoulos; Keith Couper; Patrick Van de Voorde; Patrick Druwé; Marieke Blom; Gavin D Perkins; Ileana Lulic; Jana Djakow; Violetta Raffay; Gisela Lilja; Leo Bossaert Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.826