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Hello - it's your friendly neighborhood health economist (and I have worked on a topic adjacent to ECMO machines). ECMO is unambiguously cost effective (even a
by huitzitziltzin 2y ago
Hello - it's your friendly neighborhood health economist (and I have worked on a topic adjacent to ECMO machines).
ECMO is unambiguously cost effective (even at US prices!) for the infant. (I'm not defending US prices - needless to say if anything is cost effective at US prices it's passed the hardest cost effectiveness test.) It's also cost effective (even at US prices) for the older patient. Honestly the cited figure of $213,000 is nothing compared to the value of a statistical life (for the infant) or a bit under half of one (for the adult)
There should be more of these machines and they should be in wider use. The possible impact on heart attack mortality alone is enough to justify wider investment and exploratory use more broadly, even if the precise effects end up being smaller than that's cited in the article.
This is a great example of technological change pushing the boundaries of what's possible in health care. (And frankly... even though I am not defending US health care prices, a high price for this new technology is exactly the kind of signal you want to send to entrepreneurial types, several of whom appear in the article. If ECMO can be taken out of the ICU (by some future version of the machine) that seems highly likely to generate huge benefits.)
Sure, there are some moral issues to be worked out. Those issues would be much better worked out while a bunch of patients who would otherwise died are plugged into ECMO machines...
- nradov 2y agoIf we want to look at this purely in terms of economics then we have to "discount" the life years saved with a quality adjustment. Most elderly or chronically ill people who undergo ECMO treatment are never able to live independently again even if they are able to get off the machine. I'm not saying that we shouldn't use ECMO in those cases. But we need to be realistic about probable outcomes and not expect anything like a cure.
- huitzitziltzin 2y agoYou are correct and I’m happy to discount. The older of the two patients in the original example was under 50. That’s a lot of QALYs. Even at an implausibly high discount rate it makes sense. The outcomes reported in the article are suggestive of a large decrease in mortality due to heart attack. Even assuming the effect is much smaller than reported, more widespread use of ecmo machines makes a lot of sense.
- ejstronge 2y agoI’m not a domain expert, but I haven’t seen ECMO offered to ‘old’ patients (over ~70). Do you have data on ECMO recipients’ age?