{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T04:52:44Z","timestamp":1773895964241,"version":"3.50.1"},"reference-count":41,"publisher":"Sociedade Brasileira de Cardiologia","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo  Fundamento  O choque cardiog\u00eanico (CC) refrat\u00e1rio est\u00e1 associado com altas taxas de mortalidade, e o uso de oxigena\u00e7\u00e3o por membrana extracorp\u00f3rea venoarterial (VA-ECMO, do ingl\u00eas venoarterial extracorporeal membrane oxygenation) como uma op\u00e7\u00e3o terap\u00eautica tem gerado discuss\u00f5es. Nesse sentido, sua custo-efetividade, principalmente em pa\u00edses de baixa e m\u00e9dia renda como o Brasil, continua incerto.Objetivos: Conduzir uma an\u00e1lise de custo-efetividade na perspectiva do Sistema \u00danico de Sa\u00fade (SUS) para avaliar a custo-efetividade de VA-ECMO combinado com o tratamento padr\u00e3o em compara\u00e7\u00e3o ao tratamento padr\u00e3o isolado em pacientes adultos com CC refrat\u00e1rio.  M\u00e9todos  Acompanhamos uma coorte de pacientes com CC refrat\u00e1rio tratados com VA-ECMO em centros de assist\u00eancia terci\u00e1ria do sul brasileiro. Coletamos dados de desfechos e custos hospitalares. Realizamos uma revis\u00e3o sistem\u00e1tica para complementar nossos dados e usamos o modelo de Markov para estimar a raz\u00e3o de custo-efetividade incremental (RCEI) por ano de vida ajustado pela qualidade (QALY) e por ano de vida ganho.  Resultados  Na an\u00e1lise do caso-base, a VA-ECMO gerou uma RCEI de Int$ 37 491 por QALY. An\u00e1lises de sensibilidade identificaram o custo de interna\u00e7\u00e3o, o risco relativo de sobrevida, e a sobrevida do grupo submetido \u00e0 VA-ECMO como principais vari\u00e1veis influenciando os resultados. A an\u00e1lise de sensibilidade probabil\u00edstica mostrou um benef\u00edcio do uso de VA-ECMO, com uma probabilidade de 78% de custo-efetividade no limiar recomendado de disposi\u00e7\u00e3o a pagar.  Conclus\u00f5es  Nosso estudo sugere que, dentro do SUS, VA-ECMO pode ser uma terapia custo-efetiva para o CC refrat\u00e1rio. Contudo, a escassez de dados sobre a efic\u00e1cia e de ensaios cl\u00ednicos recentes que abordem seus benef\u00edcios em subgrupos espec\u00edficos de pacientes destaca a necessidade de mais pesquisas. Ensaios cl\u00ednicos rigorosos, incluindo perfis diversos de pacientes, s\u00e3o essenciais para confirmar a custo-efetividade com uso de VA-ECMO e assegurar acesso igualit\u00e1rio a interven\u00e7\u00f5es m\u00e9dicas avan\u00e7adas dentro dos sistemas de sa\u00fade, especialmente em pa\u00edses com desigualdades socioecon\u00f4micas como o Brasil.<\/jats:p>","DOI":"10.36660\/abc.20230672","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T11:49:00Z","timestamp":1724845740000},"source":"Crossref","is-referenced-by-count":2,"title":["Custo-Efetividade da Oxigena\u00e7\u00e3o por Membrana Extracorp\u00f3rea Venoarterial no Choque Cardiog\u00eanico Refrat\u00e1rio: Um Estudo na Perspectiva Brasileira"],"prefix":"10.36660","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6989-3079","authenticated-orcid":false,"given":"S\u00e9rgio Renato da Rosa","family":"Decker","sequence":"first","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital Moinhos de Vento,  Brasil; Universidade Federal do Rio Grande do Sul,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo Vugman","family":"Wainstein","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital de Clinicas de Porto Alegre,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando Luis","family":"Scolari","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital de Clinicas de Porto Alegre,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscila Raupp da","family":"Rosa","sequence":"additional","affiliation":[{"name":"Universidade Nove de Julho,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Schneider","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debora Vacaro","family":"Fogazzi","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1374-6595","authenticated-orcid":false,"given":"Geraldine","family":"Trott","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7577-464X","authenticated-orcid":false,"given":"Jonas","family":"Wolf","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassiano","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marciane Maria","family":"Rover","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luiz Ant\u00f4nio","family":"Nasi","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Eduardo","family":"Rohde","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital de Clinicas de Porto Alegre,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-2577","authenticated-orcid":false,"given":"Carisi Anne","family":"Polanczyk","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Universidade Federal do Rio Grande do Sul,  Brasil; Hospital Moinhos de Vento,  Brasil; Hospital de Clinicas de Porto Alegre,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regis Goulart","family":"Rosa","sequence":"additional","affiliation":[{"name":"Hospital Moinhos de Vento,  Brasil; Hospital Moinhos de Vento,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-0348","authenticated-orcid":false,"given":"Eduardo Gehling","family":"Bertoldi","sequence":"additional","affiliation":[{"name":"Universidade Federal do Rio Grande do Sul,  Brasil; Universidade Federal de Pelotas,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22636","published-online":{"date-parts":[[2024,8]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/03913988211070841","article-title":"Cardiogenic Shock Treated with Temporary Mechanical Circulatory Support in Brazil: The Effect of Learning Curve","volume":"45","author":"Scolari FL","year":"2022","journal-title":"Int J Artif Organs"},{"issue":"8","key":"ref2","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1038\/nrcardio.2016.96","article-title":"Management of Refractory Cardiogenic Shock","volume":"13","author":"Reyentovich A","year":"2016","journal-title":"Nat Rev Cardiol"},{"issue":"36","key":"ref3","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure","volume":"42","author":"McDonagh TA","year":"2021","journal-title":"Eur Heart J"},{"issue":"7","key":"ref4","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1093\/ehjacc\/zuad064","article-title":"Step by Step Daily Management of Short-term Mechanical Circulatory Support for Cardiogenic Shock in Adults in the Intensive Cardiac Care Unit: A Clinical Consensus Statement of the Association for Acute CardioVascular Care of the European Society of Cardiology SC, the European Society of Intensive Care Medicine, the European Branch of the Extracorporeal Life Support Organization, and the European Association for Cardio-Thoracic Surgery","volume":"12","author":"M\u00f8ller JE","year":"2023","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1093\/ejcts\/ezy374","article-title":"Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock: Patient Survival and Health-related Quality of Life","volume":"55","author":"J\u00e4\u00e4maa-Holmberg S","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1007\/s00134-016-4536-8","article-title":"Extracorporeal Life Support During Cardiac Arrest and Cardiogenic Shock: A Systematic Review and Meta-analysis","volume":"42","author":"Ouweneel DM","year":"2016","journal-title":"Intensive Care Med"},{"issue":"10410","key":"ref7","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/S0140-6736(23)01607-0","article-title":"Venoarterial Extracorporeal Membrane Oxygenation in Patients with Infarct-related Cardiogenic Shock: An Individual Patient Data Meta-analysis of Randomised Trials","volume":"402","author":"Zeymer U","year":"2023","journal-title":"Lancet"},{"key":"ref8","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations","volume":"376","author":"Husereau D","year":"2022","journal-title":"BMJ"},{"key":"ref9","series-title":"General Guidelines for all ECLS Cases","first-page":"1","volume":"1","year":"2017"},{"key":"ref10","series-title":"O Uso de Limiares de Custo-efetividade nas Decis\u00f5es em Sa\u00fade: Recomenda\u00e7\u00f5es da Comiss\u00e3o Nacional de Incorpora\u00e7\u00e3o de Tecnologias no SUS","year":"2022"},{"issue":"1","key":"ref11","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/ehjacc\/zuaa022","article-title":"Five-year Risk of Heart Failure and Death Following Myocardial Infarction with Cardiogenic Shock: A Nationwide Cohort Study","volume":"10","author":"Lauridsen MD","year":"2021","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"8","key":"ref12","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/clc.20488","article-title":"Long-term Survival and Outcomes After Hospitalization for Acute Myocardial Infarction Complicated by Cardiogenic Shock","volume":"32","author":"Drakos SG","year":"2009","journal-title":"Clin Cardiol"},{"issue":"6","key":"ref13","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1038\/nrcardio.2013.60","article-title":"Cost-effectiveness of Heart Failure Therapies","volume":"10","author":"Rohde LE","year":"2013","journal-title":"Nat Rev Cardiol"},{"issue":"1","key":"ref14","first-page":"32","article-title":"Cost-effectiveness of High, Moderate and Low-dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System","volume":"104","author":"Ribeiro RA","year":"2015","journal-title":"Arq Bras Cardiol"},{"key":"ref15","series-title":"Estat\u00edsticas de Mortalidade por Idade","year":"2023"},{"key":"ref16","series-title":"Produto Interno Bruto - PIB","year":"2023"},{"issue":"4","key":"ref17","doi-asserted-by":"crossref","first-page":"e0122760","DOI":"10.1371\/journal.pone.0122760","article-title":"A Systematic Review of Studies Eliciting Willingness-to-pay per Quality-adjusted Life Year: Does it Justify CE Threshold?","volume":"10","author":"Nimdet K","year":"2015","journal-title":"PLoS One"},{"issue":"5","key":"ref18","doi-asserted-by":"crossref","first-page":"485","DOI":"10.2217\/cer.15.38","article-title":"Systematic Overview of Cost-effectiveness Thresholds in Ten Countries Across Four Continents","volume":"4","author":"Schwarzer R","year":"2015","journal-title":"J Comp Eff Res"},{"key":"ref19","series-title":"Use of Extracorporeal Membrane Oxygenation for Cardiac Life Support in Adult Subjects","author":"Almeida N","year":"2017"},{"issue":"3","key":"ref20","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/jocs.13106","article-title":"Financial and Clinical Outcomes of Extracorporeal Mechanical Support","volume":"32","author":"Chiu R","year":"2017","journal-title":"J Card Surg"},{"issue":"14","key":"ref21","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1056\/NEJMoa2307227","article-title":"Extracorporeal Life Support in Infarct-Related Cardiogenic Shock","volume":"389","author":"Thiele H","year":"2023","journal-title":"N Engl J Med"},{"issue":"6","key":"ref22","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1161\/CIRCULATIONAHA.122.062949","article-title":"Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial","volume":"147","author":"Ostadal P","year":"2023","journal-title":"Circulation"},{"issue":"25","key":"ref23","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1056\/NEJMp1610059","article-title":"All in a Day's Work - Equity vs. Equality at a Public ICU in Brazil","volume":"375","author":"Machado FR","year":"2016","journal-title":"N Engl J Med"},{"issue":"2","key":"ref24","article-title":"Unveiling Critical Care Resiliency: Lessons From the COVID-19 Pandemic in a Resource-Limited Setting","volume":"1","author":"Rosa RG","year":"2023","journal-title":"CHEST Critical Care"},{"issue":"14","key":"ref25","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1056\/NEJMe2309395","article-title":"Routine Early ECLS in Infarct-Related Cardiogenic Shock?","volume":"389","author":"Leopold JA","year":"2023","journal-title":"N Engl J Med"},{"key":"ref26","article-title":"Clinical Impact of Mechanical Supports for Management of Post-infarction Cardiogenic Shock: A Balance Between Survival and Hemorrhagic Complications in a Single Tertiary Centre","volume":"34","author":"Marra MP","year":"2013","journal-title":"Eur Heart J"},{"issue":"4","key":"ref27","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/ijcp.12380","article-title":"Extracorporal Life Support (ECLS) in Acute Ischaemic Cardiogenic Shock","volume":"68","author":"Sattler S","year":"2014","journal-title":"Int J Clin Pract"},{"issue":"3","key":"ref28","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1053\/j.jvca.2014.09.005","article-title":"Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest: A Meta-analysis","volume":"29","author":"Xie A","year":"2015","journal-title":"J Cardiothorac Vasc Anesth"},{"issue":"4","key":"ref29","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/ckj\/sfs070","article-title":"Long-term Outcomes of Survivors of ICU Acute Kidney Injury Requiring Renal Replacement Therapy: A 10-year Prospective Cohort Study","volume":"5","author":"Schiffl H","year":"2012","journal-title":"Clin Kidney J"},{"issue":"6","key":"ref30","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1097\/CCM.0b013e3181a000cf","article-title":"Time Course of Anemia During Six Months Follow up Following Intensive Care Discharge and Factors Associated with Impaired Recovery of Erythropoiesis","volume":"37","author":"Bateman AP","year":"2009","journal-title":"Crit Care Med"},{"issue":"4","key":"ref31","doi-asserted-by":"crossref","first-page":"2576","DOI":"10.1378\/chest.128.4.2576","article-title":"Incidence and Clinical Predictors of Pulmonary Embolism in Severe Heart Failure Patients Admitted to a Coronary Care Unit","volume":"128","author":"Darze ES","year":"2005","journal-title":"Chest"},{"issue":"2","key":"ref32","article-title":"Incidence of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism: A Contemporary View of the Published Literature","volume":"49","author":"Ende-Verhaar YM","year":"2017","journal-title":"Eur Respir J"},{"key":"ref33","series-title":"Venous Thromboembolism in Over 16s: Reducing the Risk of Hospital-acquired Deep Vein Thrombosis or Pulmonary Embolism","year":"2018"},{"issue":"3","key":"ref34","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ijcard.2011.06.046","article-title":"Cost-effectiveness of Cardiac Resynchronization Therapy in Patients with Heart Failure: The Perspective of a Middle-income Country's Public Health System","volume":"163","author":"Bertoldi EG","year":"2013","journal-title":"Int J Cardiol"},{"issue":"10","key":"ref35","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.cardfail.2018.04.008","article-title":"Cost-Effectiveness Benefits of a Disease Management Program:The REMADHE Trial Results","volume":"24","author":"Bocchi EA","year":"2018","journal-title":"J Card Fail"},{"issue":"5","key":"ref36","first-page":"577","article-title":"Cost-effectiveness of Implantable Cardioverter Defibrillators in Brazil in the Public and Private Sectors","volume":"95","author":"Ribeiro RA","year":"2010","journal-title":"Arq Bras Cardiol"},{"issue":"1","key":"ref37","first-page":"29","article-title":"The Economic Burden of Heart Conditions in Brazil","volume":"111","author":"Stevens B","year":"2018","journal-title":"Arq Bras Cardiol"},{"issue":"10","key":"ref38","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1007\/s11136-015-0991-x","article-title":"Brazilian Urban Population Norms Derived from the Health-related Quality of Life SF-6D","volume":"24","author":"Ciconelli RM","year":"2015","journal-title":"Qual Life Res"},{"issue":"3","key":"ref39","doi-asserted-by":"crossref","first-page":"109","DOI":"10.3988\/jcn.2011.7.3.109","article-title":"Disability-adjusted Life Years Analysis: Implications for Stroke Research","volume":"7","author":"Hong KS","year":"2011","journal-title":"J Clin Neurol"},{"key":"ref40","series-title":"Global Burden of Disease 2004 Update: Disability Weights for Diseases and Conditions","year":"2008"},{"issue":"11","key":"ref41","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/S2214-109X(15)00069-8","article-title":"Disability Weights for the Global Burden of Disease 2013 Study","volume":"3","author":"Salomon JA","year":"2015","journal-title":"Lancet Glob Health"}],"container-title":["Arquivos Brasileiros de Cardiologia"],"original-title":["Cost-Utility of Venoarterial Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock: A Brazilian Perspective Study"],"link":[{"URL":"https:\/\/abccardiol.org\/wp-content\/uploads\/articles_xml\/0066-782X-abc-121-8-e20230672\/0066-782X-abc-121-8-e20230672.x47225.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T11:49:22Z","timestamp":1724845762000},"score":1,"resource":{"primary":{"URL":"https:\/\/abccardiol.org\/article\/custo-efetividade-da-oxigenacao-por-membrana-extracorporea-venoarterial-no-choque-cardiogenico-refratario-um-estudo-na-perspectiva-brasileira\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["S0066-782X2024000800303"],"URL":"https:\/\/doi.org\/10.36660\/abc.20230672","relation":{"is-translation-of":[{"id-type":"doi","id":"10.36660\/abc.20230672i","asserted-by":"subject"},{"id-type":"doi","id":"10.36660\/abc.20230672i","asserted-by":"object"}]},"ISSN":["1678-4170","0066-782X"],"issn-type":[{"value":"1678-4170","type":"electronic"},{"value":"0066-782X","type":"print"}],"subject":[],"published":{"date-parts":[[2024,8]]},"article-number":"e20230672"}}