Key result
Mechanical ventilation and ECMO confer significant clinical value, adding up to ~57 QALYs.
Why the study?
Resources for managing medical equipment inventories are frequently scarce and must be prioritised to confer maximum benefit per unit expenditure.
What is the clinical value and cost-effectiveness of mechanical ventilation and ECMO in acute healthcare settings?
Systematic Review
What is the clinical value and cost-effectiveness of mechanical ventilation and ECMO in acute healthcare settings?
Estimates of clinical value for ECMO carry greater uncertainty than those for mechanical ventilation, highlighting the need for more robust prospective data to inform equipment management and prioritization.
Greater uncertainty in ECMO than MV value estimates warrants caution in prioritization; leaves open need for prospective data to guide decisions.
• MV & ECMO clinical value estimates exist in health economics articles, among others. • Conferred clinical value varies depending on patient population characteristics. • Higher quality data and more sub-group analyses exist for MV than for ECMO. • Institution-specific clinical value estimates will be less certain for ECMO than MV. Acute healthcare providers operate large, diverse medical equipment inventories. Resources for managing these inventories is frequently scarce so must be prioritised such that maximum benefit is conferred per unit of expenditure. This review identifies publications which have discussed the clinical value conferred by mechanical ventilation (MV) and by extra corporeal membrane oxygenation (ECMO). Respectively, mechanical ventilators and ECMO units are necessary to deliver these therapies. Systematic searches for publications which discuss the clinical value conferred by MV and by ECMO were conducted. The identified articles included reviews, prospective studies, retrospective studies, and models. Most presented findings in terms of the cost-effectiveness ratio. The patient populations studied, and analytical methods used varied widely. The clinical value conferred by MV varied with dependencies on several factors including the age- and disease- profile of the patient population. It was not possible to infer these dependencies from the literature which exists for ECMO. More relevant literature existed for MV, the more mature technology, than did for ECMO. The ECMO literature also tended to be more recent and included more modelling studies and fewer prospective studies. The data extracted could inform estimates of the clinical value likely to be delivered by mechanical ventilators operated by a specific institution. Estimates for ECMO are likely to carry greater uncertainty than those for MV.
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Stell et al. (2024) conducted a systematic review in Critically ill patients with compromised respiratory or cardiac function. Mechanical ventilation and Extracorporeal membrane oxygenation (ECMO) was evaluated on Quality Assessed Life Expectancy (QALE). Mechanical ventilation and ECMO generally confer significant clinical value, with reported quality-adjusted life expectancy ranging from 0.1 to 57 QALYs for MV and 1.0 to over 20 QALYs for ECMO.
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