title: Cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  To measure the incremental cost-effectiveness of various improvements to emergency medical services (EMS) systems aimed at increasing survival after out-of-hospital cardiac arrest.
  
  
  METHODS
  We performed cost-effectiveness analysis based on (1) metaanalysis of effectiveness of the various EMS systems, (2) costing of each component of EMS systems, (3) modeling of the relationship between the proportion of cardiac arrest victims who receive CPR and the proportion of individuals trained, (4) modeling of the relationship between response time interval and the characteristics of the EMS system, (5) measurement of quality of life, and (6) decision analysis to combine the results of the first five components.
  
  
  RESULTS
  The incremental cost-effectiveness ratio for a 48-second improvement in mean response time in a one-tier EMS system yielded by the addition of more EMS providers was $368,000 per quality-adjusted life year (QALY). For improved response time in a two-tier EMS system by the addition of more basic life support (BLS)/BLS-defibrillator (BLS-D) providers to the first tier, the ratio was $53,000 per QALY with pump vehicles or $159,000 per QALY with ambulances. Change from a one-tier EMS to a two-tier EMS system by the addition of initial BLS/BLS-D providers in pump vehicles as the first tier was associated with a cost per QALY of $40,000. Change from one-tier EMS to two-tier EMS by the addition of initial BLS/BLS-D providers in ambulances as the first tier was associated with a cost per QALY of $94,000.
  
  
  CONCLUSIONS
  The most attractive options in terms of incremental cost-effectiveness were improved response time in a two-tier EMS system or change from a one-tier to a two-tier EMS system. Future research should be directed toward identification of the costs of instituting the first tier of a two-tier EMS system and identification of cost-effective methods of improving response time.
authors.affiliation: Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa Civic Hospital, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Nichol
authors.forename: A
authors.initials: A
authors.lastname: Laupacis
authors.forename: I G
authors.initials: IG
authors.lastname: Stiell
authors.forename: K
authors.initials: K
authors.lastname: O'Rourke
authors.forename: A
authors.initials: A
authors.lastname: Anis
authors.forename: H
authors.initials: H
authors.lastname: Bolley
authors.forename: A S
authors.initials: AS
authors.lastname: Detsky
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004554:Electric Countershock / Q000191:economics; D004632:Emergency Medical Services / Q000191:economics*; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008020:Life Support Care / Q000191:economics; D009864:Ontario; D011930:Reaction Time