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OBJECTIVE. To assess the long-term cost-effectiveness of extracorporeal membrane oxygenation (ECMO) for mature newborn infants with severe respiratory failure. METHODS. A prospective economic evaluation was conducted alongside a pragmatic randomized, controlled trial in which 185 infants were randomly allocated to ECMO (n = 93) or conventional management (n = 92) and then followed up to 7 years of age. Information about their use of health services during the follow-up period was combined with unit costs (£, 2002-2003 prices) to obtain a net cost per child. The cost-effectiveness of neonatal ECMO was expressed in terms of incremental cost per additional life year gained and incremental cost per additional disability-free life year gained. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness-to-pay thresholds held by decision-makers for an additional life year and for an additional disability-free life year. RESULTS. Over 7 years, neonatal ECMO was effective at reducing known death or severe disability. Mean health service costs during the first 7 years of life were £30 270 in the ECMO group and £10 229 in the conventional management group, generating a mean cost difference of £20 041 that was statistically significant. The incremental cost per life year gained was estimated at £13 385. The incremental cost per disability-free life year gained was estimated at £23 566. At the notional willingness-to-pay threshold of £30 000 for an additional life year, the probability that neonatal ECMO is cost-effective at 7 years was estimated at 0.98. This translated into a mean net benefit of £24 362 for each adoption of neonatal ECMO rather than conventional management. CONCLUSIONS. This study provides rigorous evidence of the cost-effectiveness of neonatal ECMO during childhood. Copyright © 2006 by the American Academy of Pediatrics.

Original publication




Journal article



Publication Date





1640 - 1649