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

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 1,000 increase in the total healthcare cost was associated with an increase in the three-year all-cause mortality (hazard ratio, 1.01; 95% CI: 1.00–1.01; P=0.015). CONCLUSIONS: After one year, ECMO survivors accrued USD 46,308 in healthcare costs in South Korea. An increase in the total healthcare cost was associated with a higher risk of three-year all-cause mortality among ECMO survivors.