OBJECTIVES: Most of the clinicians use invasive mechanical ventilation in COVID- 19 patients with moderate or severe Acute Respiratory Distress Syndrome and in those who have substantial gas exchange anomalies in the setting of possibly reversible acute respiratory failure may benefit from Extracorporeal Membrane Oxygenation (ECMO) as a salvage therapy. This research aims to assess the cost- effectiveness of use of VV- ECMO when compared to that of invasive mechanical ventilation, in COVID- 19 patients with ARDS.

METHODS: In individuals infected with Covid-19, a cost-effectiveness analysis was performed comparing Venovenous Extracorporeal Membrane Oxygenation (VV- ECMO) to that of invasive mechanical ventilation. A decision tree was constructed using data from previously published studies and other government websites comparing the use of VV- ECMO to that of invasive mechanical ventilation in COVID- 19 patients with severe ARDS.

RESULTS: VV- ECMO when used in COVID-19 ARDS patients gains 1.89 QALY, in the time horizon of one month whereas invasive mechanical ventilation mode gains only 0.48 QALY with an ICER value of ₹ 3,35,311.78 per QALY gained. When the WTP is greater than ₹ 4,00,000, VV- ECMO is almost 85% cost effective. One- way sensitivity analysis reveals that the uncertainty in the probability of patients alive after receiving VV- ECMO, probability of patients having no adverse reaction after receiving VV- ECMO and cost of VV- ECMO, have the greatest impact on the ICER.

CONCLUSIONS: Although managing COVID- 19 patients with ARDS with VV- ECMO is comparatively costlier than that of managing with invasive mechanical ventilation in monetary terms, the QALY gained is fairly higher in case of VV- ECMO and is cost effective. It was also observed from the studies that there is reduced length of stay in patients under VV- ECMO compared to the alternative.