Costs and complications of extracorporeal membrane oxygenation therapy in Australia and New Zealand

Background: Extracorporeal membrane oxygenation (ECMO) is a life-saving form of cardiopulmonary support for patients with severe refractory cardiopulmonary disease. It is a resource-intensive intervention requiring specialised equipment and personnel, with significant associated costs. This study aimed to determine the costs of care for patients who received ECMO in Australia and New Zealand, and to determine the impact of ECMO-related complications on costs. Methods: A prospective observational clinical registry analysis was performed using data from 1,345 patients commenced on ECMO in Australia and New Zealand between 2019 and 2022. Per patient resource use was costed based on data from hospital admission to hospital discharge. Key outcomes were mean total patient cost and costs associated with complications. Costs were reported in 2022 Australian Dollars. Results: Mean costs and daily ECMO costs varied significantly between ECMO modes. While total costs for venovenous (VV) ECMO was significantly more expensive (mean $287,264, standard deviation [SD] $251,193) than venoarterial (VA) ECMO (mean $215,128, SD $162,418) and extracorporeal cardiopulmonary resuscitation (ECPR) (mean $121,274, SD $131,893), daily costs while receiving ECMO were least costly for VV ECMO. Complications occurred in 57% of patients. Cost incrementally increased with number of complications. Mean costs were significantly higher in patients with infection (mean $292,197, SD $217,806) compared to those without (mean $161,674, SD $165,175). Key cost drivers were intensive care and hospital length of stay, and ECMO-related procedure costs. Conclusions: ECMO costs were high, with venovenous ECMO being most expensive due to an increased length of stay. Total patient cost increased with additional ECMO complications. Accurate ECMO costs and complications data can enable informed health budgeting and identification of areas for clinical improvement. (Trial registration: NCT03793257).