Marten J. Poley - Erasmus Universiteit Rotterdam

76Chapter 5Table 5.3 Direct Medical Costs for ECMO and Control PatientsCDH MAS TotalECMO patients n = 23 n = 31 n = 54Variable costs Medical supplies € 2,642 € 1,396 € 1,927Diagnostics € 11,292 € 7,585 € 9,164Medications € 5,540 € 2,324 € 3,694Interventions € 1,595 € 165 € 774ECMO * € 7,454 € 5,154 € 6,134Various € 128 € 62 € 90Costs of personnel € 14,139 € 7,845 € 10,525Fixed costs € 8,002 € 4,940 € 6,244Total costs € 50,792 € 29,472 € 38,553Control patients n = 24 n = 21 n = 45Costs of stay on IC First day € 855 € 669 € 768Subsequent days € 4,494 € 9,542 € 6,850Costs of stay on MC € 2,002 € 1,342 € 1,694Diagnostics € 5,179 € 9,515 € 7,203Interventions € 736 € 841 € 785Total costs € 13,267 € 21,909 € 17,300*All variables expressed by means. Abbreviations: IC, intensive care; MC, medium care.This category involves resource use directly related to ECMO: costs of thecannulation/decannulation procedures, costs of priming the ECMO circuit, costs of the ECMOpack, costs of the ECMO run, device costs, and costs of Astrup and ACT (activated clottingtime) tests.Direct medical costs for treatment of patients in the control group werecomparatively low with an average of € 17,300 (Table 5.3).Thus, the difference in costs was calculated at an average of € 21,253. For a part,this difference is due to the enhanced survival rates, which results in longerhospital stays.EffectsDuring the study period, 57 of all 244 ECMO patients (23%) deceased, with amean life span of 28 days (median, 18 days). Of all 46 control patients, 34 (74%)had died (mean life span, 4 days; median, 2 days). In this study's follow-up, nopatients were found that died after their first year of life. For CDH patients, thesurvival rate was 0.04 without ECMO and 0.52 with ECMO, as seen in Figure 5.1.For MAS patients, survival without ECMO was 0.50, as compared to 0.94 in theECMO era (Figure 5.2). Regarding the CDH patients, the relative risk of death ofECMO patients compared to the control group was 0.50 (95% confidence interval,0.40 to 0.62). For the patients with MAS, the relative risk of death amounted to0.13 (95% confidence interval, 0.06 to 0.27).