Lars W Andersen1, Mathias J Holmberg2, Asger Granfeldt3, Lyndon P James4, Lisa Caulley5. 1. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: lwandersen@clin.au.dk. 2. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 3. Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark. 4. Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA, USA. 5. Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Despite a consistent association with improved outcomes, public automated external defibrillators (AEDs) are rarely used in out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost-effectiveness. METHODS: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the United States over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. RESULTS: The no AED strategy resulted in 1.63 QALYs at a cost of $28,964. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. In several sensitivity analyses across a plausible range of health care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a willingness-to-pay threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. CONCLUSION: Public AEDs are a cost-effective public health intervention in the United States. These findings support widespread dissemination of public AEDs.
BACKGROUND: Despite a consistent association with improved outcomes, public automated external defibrillators (AEDs) are rarely used in out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost-effectiveness. METHODS: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the United States over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. RESULTS: The no AED strategy resulted in 1.63 QALYs at a cost of $28,964. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. In several sensitivity analyses across a plausible range of health care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a willingness-to-pay threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. CONCLUSION: Public AEDs are a cost-effective public health intervention in the United States. These findings support widespread dissemination of public AEDs.
Keywords:
Automated external defibrillators; Cardiac arrest; Cardiopulmonary resuscitation; Cost-effectiveness analysis; Public; Public health; United States
Authors: Madeleine Benson; Terry P Brown; Scott Booth; Felix Achana; Christopher M Smith; Gill Price; Matt Ward; Claire Hawkes; Gavin D Perkins Journal: Resusc Plus Date: 2022-07-26
Authors: Theresa M Olasveengen; Mary E Mancini; Gavin D Perkins; Suzanne Avis; Steven Brooks; Maaret Castrén; Sung Phil Chung; Julie Considine; Keith Couper; Raffo Escalante; Tetsuo Hatanaka; Kevin K C Hung; Peter Kudenchuk; Swee Han Lim; Chika Nishiyama; Giuseppe Ristagno; Federico Semeraro; Christopher M Smith; Michael A Smyth; Christian Vaillancourt; Jerry P Nolan; Mary Fran Hazinski; Peter T Morley Journal: Resuscitation Date: 2020-10-21 Impact factor: 5.262