The economic burden and long-term mortality in survivors of extracorporeal membrane oxygenation in South Korea

Abstract

Background: The economic burden for extracorporeal membrane oxygenation (ECMO) survivors is a critical issue. We investigated the total healthcare costs for one year following ECMO support and its association with three-year all-cause mortality.Methods: This population-based cohort study used data from the National Health Insurance Service (NHIS) in South Korea. Adult ECMO survivors (age ≥18 years who were alive ≥365 days following ECMO support) from January 1, 2005, to December 31, 2018, were included. The total healthcare costs for one year included all the expenses for hospital and outpatient clinic visits after discharge.Results: In total, 6,044 patients were included in the final analysis comprising 3,566 (59.0%) in the cardiac indication group, 658 (10.9%) in the respiratory indication group, and 1,820 (30.1%) in the "other" group.The median total healthcare cost was United States Dollars (USD) 46,308.0 [interquartile range (IQR): 25,727.0-86,924.8]. The median ECMO support and hospital stay durations were three (IQR: 1-7) days and 25 (IQR: 15-31) days. In the multivariable Cox regression model, a USD 1000 increase in the total healthcare cost was associated with an increase in the three-year all-cause mortality (hazard ratio, 1.01; 95%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Of 28 SES studies, 14 studies (50%) were conducted outside the United States. Nine examined Income in the South Korean National Health Insurance (NHI), with four finding no association with ECMO complications or mortality (108)(109)(110)(111) and five reporting statistical associations without a consistent dose-dependent income response (112)(113)(114)(115)(116). One Chinese National Clinical Improvement System population-level study found that areas with mid-level Gross Domestic Product (vs high) had a lower mortality (117) and single-center study showed employment was associated with quality of life in survivors (118).…”

Health benefit and economic impact of utilising ECMO in COVID-19 patients: patient or cost first

“…In this issue of the Annals of Translational Medicine, Oh et al ( 4 ) shared the results from a population-based, nationwide, retrospective cohort study. This study comprised a total of 6,044 patients, with a range of indications requiring ECMO support, such as cardiac (59.0%), respiratory (10.9%) and other causes (30.1%).…”

“…Initial entry into type 2 pneumocytes in the lungs via ACE2 receptors has been shown to trigger an inflammatory cytokine response, which can subsequently lead to acute respiratory distress syndrome (ARDS) ( 3 ). This is where extracorporeal membrane oxygenation (ECMO) comes into play; displaying its benefits as a rescue therapy in the intensive care unit when mechanical ventilation has failed in this regard ( 4 ). The utilisation of ECMO was soon encouraged by the WHO and Extracorporeal Life Support Organisation (ELSO) and advocated through interim guidelines as part of the supportive management of patients ( 5 ).…”

“…This supportive therapy was initially recommended when maximal conventional therapies with coronavirus disease 2019 (COVID-19)-related ARDS failed, functioning as a rescue cardiopulmonary bypass to reduce the effects of the virus on the cardiorespiratory system ( 6 ). Despite several, recent studies highlighting improved patient outcomes when ECMO is utilised ( 1 ), there is also concern over the economic burden of using ECMO during this pandemic ( 4 ). Current data concerning this topic is limited within reported literature and it requires further evaluation to ensure that the current guidelines on the use of ECMO for COVID-19 related ARDS is justified and safe.…”

“…This supportive therapy was initially recommended when maximal conventional therapies with coronavirus disease 2019 (COVID-19)-related ARDS failed, functioning as a rescue cardiopulmonary bypass to reduce the effects of the virus on the cardiorespiratory system (6). Despite several, recent studies highlighting improved patient outcomes when ECMO is utilised (1), there is also concern over the economic burden of using ECMO during this pandemic (4).…”