Joachim Marti1, Claire Hulme2, Zenia Ferreira2, Silviya Nikolova2, Ranjit Lall3, Charlotte Kaye3, Michael Smyth4, Charlotte Kelly2, Tom Quinn5, Simon Gates3, Charles D Deakin6, Gavin D Perkins7. 1. Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, St. Mary's Campus, 10th Floor QEQM Building, 2 Praed Street, London W2 1NY, UK. Electronic address: j.marti@imperial.ac.uk. 2. Academic Unit of Health Economics, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, UK. 3. Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK. 4. Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, West Midlands, DY5 1LX, UK. 5. Faculty of Health, Social Care and Education, Kingston University London and St. George's, University of London, London, SW17 0RE, UK. 6. South Central Ambulance Service NHS Foundation Trust, Otterbourne SO21 2RU, UK; Respiratory BRU, University Hospital Southampton, Southampton SO16 6YD, UK. 7. Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Heart of England NHS Foundation Trust, Bordesley Green, Birmingham, B9 5SS, UK.
Abstract
AIM: To assess the cost-effectiveness of LUCAS-2, a mechanical device for cardiopulmonary resuscitation (CPR) as compared to manual chest compressions in adults with non-traumatic, out-of-hospital cardiac arrest. METHODS: We analysed patient-level data from a large, pragmatic, multi-centre trial linked to administrative secondary care data from the Hospital Episode Statistics (HES) to measure healthcare resource use, costs and outcomes in both arms. A within-trial analysis using quality adjusted life years derived from the EQ-5D-3L was conducted at 12-month follow-up and results were extrapolated to the lifetime horizon using a decision-analytic model. RESULTS: 4471 patients were enrolled in the trial (1652 assigned to the LUCAS-2 group, 2819 assigned to the control group). At 12 months, 89 (5%) patients survived in the LUCAS-2 group and 175 (6%) survived in the manual CPR group. In the vast majority of analyses conducted, both within-trial and by extrapolation of the results over a lifetime horizon, manual CPR dominates LUCAS-2. In other words, patients in the LUCAS-2 group had poorer health outcomes (i.e. lower QALYs) and incurred higher health and social care costs. CONCLUSION: Our study demonstrates that the use of the mechanical chest compression device LUCAS-2 represents poor value for money when compared to standard manual chest compression in out-of-hospital cardiac arrest.
AIM: To assess the cost-effectiveness of LUCAS-2, a mechanical device for cardiopulmonary resuscitation (CPR) as compared to manual chest compressions in adults with non-traumatic, out-of-hospital cardiac arrest. METHODS: We analysed patient-level data from a large, pragmatic, multi-centre trial linked to administrative secondary care data from the Hospital Episode Statistics (HES) to measure healthcare resource use, costs and outcomes in both arms. A within-trial analysis using quality adjusted life years derived from the EQ-5D-3L was conducted at 12-month follow-up and results were extrapolated to the lifetime horizon using a decision-analytic model. RESULTS: 4471 patients were enrolled in the trial (1652 assigned to the LUCAS-2 group, 2819 assigned to the control group). At 12 months, 89 (5%) patients survived in the LUCAS-2 group and 175 (6%) survived in the manual CPR group. In the vast majority of analyses conducted, both within-trial and by extrapolation of the results over a lifetime horizon, manual CPR dominates LUCAS-2. In other words, patients in the LUCAS-2 group had poorer health outcomes (i.e. lower QALYs) and incurred higher health and social care costs. CONCLUSION: Our study demonstrates that the use of the mechanical chest compression device LUCAS-2 represents poor value for money when compared to standard manual chest compression in out-of-hospital cardiac arrest.
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Authors: Michelle Samuel; Jean-Claude Tardif; Paul Khairy; François Roubille; David D Waters; Jean C Grégoire; Fausto J Pinto; Aldo P Maggioni; Rafael Diaz; Colin Berry; Wolfgang Koenig; Petr Ostadal; Jose Lopez-Sendon; Habib Gamra; Ghassan S Kiwan; Marie-Pierre Dubé; Mylène Provencher; Andreas Orfanos; Lucie Blondeau; Simon Kouz; Philippe L L'Allier; Reda Ibrahim; Nadia Bouabdallaoui; Dominic Mitchell; Marie-Claude Guertin; Jacques Lelorier Journal: Eur Heart J Qual Care Clin Outcomes Date: 2021-09-16