Objective:  The aim of this study was to assess the cost-effectiveness of early versus late initiation of extracorporeal membrane oxygenation (ECMO) in pediatric patients with acute respiratory distress syndrome admitted to the intensive care unit.

Methods:  A cost-effectiveness analysis was conducted from the hospital provider perspective, comparing early (≤7 days) versus late (>7 days) initiation of ECMO. Direct medical costs and 90-day survival were incorporated into a decision tree to estimate the incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were performed using a willingness-to-pay threshold equivalent to three times the Colombian gross domestic product per capita.

Results:  Among 78 patients, most patients received early ECMO initiation, and this strategy was associated with similar mortality and comparable total direct medical costs compared with late initiation. Probabilistic simulations indicated a higher probability of cost-effectiveness for early initiation across different willingness-to-pay thresholds. Cost parameters were the main drivers of variability in the incremental cost-effectiveness ratio.

Conclusions:  No statistically significant differences were observed between early and late ECMO initiation in survival or costs. A possible economic trend favoring early initiation should be interpreted cautiously, given limited statistical power.