Marten J. Poley - Erasmus Universiteit Rotterdam

78Chapter 5Figure 5.3 illustrates one-year survival rates with ECMO for each birth yearcohort, combined with the annual number of patients treated with ECMO. Withtime elapsing, the number of ECMO patients increased considerably, whereas thesurvival rates improved only slightly (but with decreasing standard deviation ofthe data). As an additional analysis, we finally compared one-year survival ratesof the first 25 and 50 ECMO patients to the results after excluding the first 25 and50 cases. For the first 25 ECMO patients, the survival rate was lower than therate after excluding these 25 patients (0.72 v 0.77; P = 0.57). Similarly,comparing the first 50 patients with the situation of leaving out these patients, nostatistically significant difference in survival was found (0.74 v 0.77; P = 0.62).Cost-effectivenessFrom the above, it follows that for the patients with CDH costs per additionalsurvivor amounted to € 78,455, or € 3,153 per life-year gained. For the patientswith MAS, costs per additional survivor were calculated at € 17,287, or € 697 perlife-year gained.Sensitivity analysesThe main conclusions are quite insensitive to the assumptions regarding thesurvivors' life-expectancy and the discount rate, as appears from the extremescenarios. In the best-case scenario, cost-effectiveness ratios amounted to € 881per life-year gained in CDH and € 195 per life-year gained in MAS. Even in theworst-case scenario, cost-effectiveness (€ 3,858 and € 854 per life-year gained inCDH and MAS respectively) was still good.Figure 5.335Annual Numbers of Patients Treated with ECMO and Annual One-Year SurvivalRates (CDH and MAS Patients Combined)1,0300,90,8250,7Annual number of patients treated with ECMO20151050,60,50,40,30,20,1One-year survival rate with ECMO01991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001Year of Birth0,0