Potential cost-effectiveness of public access defibrillation in the United States.
BACKGROUND
Approximately 360,000 Americans experience sudden cardiac arrest each year; current treatments are expensive and not very effective. Public access defibrillation (PAD) is a novel treatment for out-of-hospital sudden cardiac arrest that refers to use of automated external defibrillators by the lay public or by nonmedical personnel such as police. A clinical trial has been proposed to evaluate the effectiveness of public access defibrillation, but it is unclear whether such early defibrillation will offer sufficient value for money. Our objective was to estimate the potential cost-effectiveness of public access defibrillation by use of decision analysis.


RESULTS
A decision model compared the potential cost-effectiveness of standard emergency medical services (EMS) systems with that of EMS supplemented by PAD. We considered defibrillation by lay responders or police, using an analysis with a US health-care perspective. Input data were derived from published data or fiscal databases. Future costs and effects were discounted at 3%. Monte Carlo simulation was performed to estimate the variability in the costs and effects of each program. Sensitivity analyses assessed the robustness of the results to changes in input data. A standard EMS system had a median cost of $5900 per cardiac arrest patient (interquartile range, IQR, $3200 to $10,900) and yielded a median of 0.25 quality-adjusted life years (IQR, 0.20 to 0.30). PAD by lay responders had a median incremental cost of $44,000 per additional quality-adjusted life year (IQR, $29,000 to $68,900). PAD by police had a median incremental cost of $27,200 per additional quality-adjusted life year (IQR, $15,700 to $47,800). The results were sensitive to changes in the cost and relative survival benefit of PAD.


CONCLUSIONS
Although more expensive than standard EMS for sudden cardiac arrest, PAD may be economically attractive. The effectiveness and cost-effectiveness of PAD should be assessed in a randomized, controlled trial.
Nichol
G
G
Loeb Medical Research Institute, University of Ottawa, Canada.
Hallstrom
A P
AP
Ornato
J P
JP
Riegel
B
B
Stiell
I G
IG
Valenzuela
T
T
Wells
G A
GA
White
R D
RD
Weisfeldt
M L
ML
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004554:Electric Countershock / Q000191:economics*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D016495:Police; D011633:Public Facilities / Q000191:economics*; D011634:Public Health; D011640:Public Policy; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States; D014504:Urban Health