{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:18:23Z","timestamp":1790299103033,"version":"4.1.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Objectives:<\/jats:title>\n To evaluate the cost-effectiveness of implementing an extracorporeal cardiopulmonary resuscitation (ECPR) strategy for refractory out-of-hospital cardiac arrest (OHCA) compared with current practice in Singapore, where it is not routinely used.<\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n We performed a simulation-based cost-effectiveness analysis using a decision tree to model acute phase and a Markov model for long-term outcomes over a lifetime horizon, from a healthcare provider perspective.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Singapore healthcare system.<\/jats:p>\n <\/jats:sec>\n \n Patients:<\/jats:title>\n Nontraumatic adult OHCA patients from Singapore with initial shockable rhythm and no prehospital return of spontaneous circulation were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Interventions:<\/jats:title>\n We modeled the implementation of an ECPR strategy and compared it with current practice using only conventional cardiopulmonary resuscitation. Transition probabilities of existing practice were derived from the nationwide Singapore OHCA registry (Pan-Asian Resuscitation Outcomes Study: PAROS), (2010\u20132016), while ECPR outcomes were based on the Comprehensive Registry of Intensive Care for OHCA Survival in Osaka (Osaka CRITICAL study) (2012\u20132019). Costs and quality-adjusted life-years (QALYs) were compared between strategies, with scenario analyses conducted to assess the impact of lower age eligibility thresholds and increased transport time to extracorporeal membrane oxygenation-capable hospitals. Incremental cost-effectiveness ratios (ICERs) were estimated using a willingness-to-pay threshold of S$45,000 per QALY.<\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results:<\/jats:title>\n \n A total of 1462 OHCA cases from Singapore were analyzed; the mean age of patients was 57 years (\n sd<\/jats:sc>\n , 11 yr), and 87% were male. In base-case analysis, ICER was estimated at $34,320\/QALY, with a positive net monetary benefit of $8,532. Scenario analyses demonstrated that an age-restricted ECPR strategy (< 65 yr) yielded a similar ICER ($33,469\/QALY) to the base case. In contrast, incorporating a 10-minute transport extension slightly exceeded the willingness-to-pay threshold ($47,158\/QALY).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In this modeling study, adopting an ECPR strategy for OHCA in Singapore was likely to be cost-effective across different age-based eligibility thresholds; however, it was sensitive to delays in transport time. Further implementation research is important to guide scale-up and policy decisions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007153","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:01:22Z","timestamp":1778684482000},"page":"1721-1732","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Modeling the Cost-Effectiveness of Incorporating Extracorporeal Cardiopulmonary Resuscitation Strategy in Out-of-Hospital Cardiac Arrest Patients"],"prefix":"10.1097","volume":"54","author":[{"given":"Nuraini","family":"Nazeha","sequence":"first","affiliation":[{"name":"Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-476X","authenticated-orcid":false,"given":"Yohei","family":"Okada","sequence":"additional","affiliation":[{"name":"Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore."},{"name":"Pre-Hospital and Emergency Research Centre, Health Services Research and Population Health, Duke-NUS Medical School, Singapore."},{"name":"Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur","family":"Shahidah","sequence":"additional","affiliation":[{"name":"Pre-Hospital and Emergency Research Centre, Health Services Research and Population Health, Duke-NUS Medical School, Singapore."},{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew Jose","family":"Chakaramakkil","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kollengode","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Cardiothoracic Intensive Care Unit, National University Heart Centre Singapore, National University Health System, Singapore."},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeyuki","family":"Kiguchi","sequence":"additional","affiliation":[{"name":"Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Takegawa","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, The University of Osaka, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuro","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Osaka Metropolitan University, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuhisa","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, The University of Osaka, Osaka, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taku","family":"Iwami","sequence":"additional","affiliation":[{"name":"Department of Preventive Services, Graduate School of Medicine, Kyoto University, Kyoto, Japan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Graves","sequence":"additional","affiliation":[{"name":"Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Eng Hock","family":"Ong","sequence":"additional","affiliation":[{"name":"Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore."},{"name":"Pre-Hospital and Emergency Research Centre, Health Services Research and Population Health, Duke-NUS Medical School, Singapore."},{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeewa","family":"Kularatna","sequence":"additional","affiliation":[{"name":"Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore."},{"name":"Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, 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