(1317) Cost Comparison of Bivalirudin and Heparin in Pediatric Extracorporeal Membrane Oxygenation (ECMO)

Introduction: Heparin has been the historic standard of anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO). There has been a recent practice shift to bivalirudin however some centers have cited cost as a reason to avoid this change. This study aims to analyze the cost per hour of ECMO while comparing bivalirudin versus the standard anticoagulation of unfractionated heparin (UFH).

Methods: A single center retrospective study was conducted on all ECMO runs that utilized anticoagulation within the pediatric and cardiac intensive care units (PICU and CICU) from January 1, 2019, through May 31, 2023. ECMO runs were categorized into heparin or bivalirudin anticoagulation groups based upon intention-to-treat. A cost breakdown of anticoagulation drugs, ECMO components or circuit changes, lab draws, and blood products were analyzed to determine the total hourly cost of ECMO. Secondary endpoints of survival, bleeding complications, reduction of lab draws, and blood products were evaluated.

Results: One hundred nineteen patients with 138 ECMO runs were evaluated. Ninety-four runs (68.1%) were initiated on heparin and 44 (31.9%) on bivalirudin. The median total costs per hour of ECMO were $73.50 for heparin patients and $67.50 for bivalirudin (p = 0.998). While drug costs were more with bivalirudin (p=0.020), lab costs were significantly less (p = < 0.001) as well as a reduction of lab draws (p = < 0.001). There was no significant difference in survival to decannulation (80.4% and 77.3%, p = 0.67), discharge (55.4% and 68.2%, p = 0.156), major bleeds (63.8% and 59.1%, p = 0.592), or product requirement (p = 0.44) between heparin and bivalirudin.

Conclusions: The cost analysis revealed no significant difference in the total cost per hour of ECMO between the heparin and bivalirudin groups. Clinical outcomes, including survival to decannulation and discharge, and the incidence of major bleeding, were also comparable between the two groups. This study suggests that bivalirudin is a cost-effective alternative to heparin for anticoagulation in pediatric ECMO without compromising patient outcomes and the cost of the drug is likely relieved by the reduced lab draws combined with a cheaper lab assay in the bivalirudin group.