Cost effectiveness of defibrillation by targeted responders in public settings

Graham Nichol, T. Valenzuela, D. Roe, L. Clark, E. Huszti, G. A. Wells

Research output: Contribution to journalArticle

74 Scopus citations

Abstract

Background - Out-of-hospital cardiac arrest is frequent and has poor outcomes. Defibrillation by trained targeted nontraditional responders improves survival versus historical controls, but it is unclear whether such defibrillation is a good value for the money. Therefore, this study estimated the incremental cost effectiveness of defibrillation by targeted nontraditional responders in public settings by using decision analysis. Methods and Results - A Markov model evaluated the potential cost effectiveness of standard emergency medical services (EMS) versus targeted nontraditional responders. Standard EMS included first-responder defibrillation followed by advanced life support. Targeted nontraditional responders included standard EMS supplemented by defibrillation by trained lay responders. The analysis adopted a US societal perspective. Input data were derived from published or publicly available data. Future costs and effects were discounted at 3%. Monte Carlo simulation and sensitivity analyses assessed the robustness of results. Standard EMS had a median of 0.47 (interquartile range [IQR]=0.32 to 0.69) quality-adjusted life years and a median of $14 100 (IQR=$8600 to $21 900) costs per arrest. Targeted nontraditional responders in casinos had an incremental cost of a median $56 700 (IQR=$44 100 to $77 200) per additional quality-adjusted life year. The results were sensitive to changes in time to defibrillation, incidence of arrest, and number of devices required to implement rapid defibrillation. Conclusions - Where cardiac arrest is frequent and response time intervals are short, rapid defibrillation by targeted nontraditional responders may be a good value for the money compared with standard EMS. The incidence of arrest should be considered when choosing locations to implement public access defibrillation.

Original languageEnglish (US)
Pages (from-to)697-703
Number of pages7
JournalCirculation
Volume108
Issue number6
DOIs
StatePublished - Aug 12 2003

Keywords

  • Cardiopulmonary resuscitation
  • Death, sudden
  • Defibrillation
  • Heart arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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