Cost‐effectiveness of plasmapheresis and hemoperfusion in COVID‐19 survivors: A six‐month follow‐up analysis after hospital discharge

Abstract Introduction To evaluate the short‐ and long‐term clinical and financial outcomes of apheresis in COVID‐19 survivors after hospital discharge. Methods Intensive care unit‐discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost‐effectiveness ratios (ICER) and to plot cost‐effectiveness planes and acceptability curves. Results A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality‐adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO 2 , 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO 2 , respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost‐effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1‐month post‐discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness‐to‐pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls. Conclusion While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long‐term cost‐effectiveness suggest that these interventions may not be economically justified for treating COVID‐19 patients. Careful evaluation is needed when considering their use in clinical practice.