Long term survival and costs per life year gained after out-of-hospital cardiac arrest.
OBJECTIVE
To study long-term survival and estimate the costs per year of survival after out-of-hospital cardiac arrest of cardiac origin.


METHODS
Cardiac arrest patients treated by the physician-manned ambulance in Oslo from January 1971 to June 1992. The condition of the patient when discharged from hospital was noted and survival followed until June 2002. Costs of the Emergency Medical Service (EMS), hospital treatment, rehabilitation and nursing homes and psychiatric institutions after discharge from hospital were included in a cost-effectiveness analysis.


RESULTS
1300 (42%) of 3065 patients receiving ALS were admitted to hospital after return of spontaneous circulation (ROSC). 1066 of these patients had a cardiac cause of the arrest, full hospital report and were found in the National Registry. Median age was 68 years (60-74) and 802 (75%) were men. 269 of the 1066 patients were discharged from hospital alive, 239 to their homes and 30 patients to rehabilitation/nursing homes or psychiatric institutions. The mean survival of the 1066 patients was 532 days. They spent mean 3.4 days in a CCU, 6.8 days in a general ward and 11.2 days in nursing/rehabilitation homes or psychiatric institutions. 30 patients were discharged to rehabilitation/nursing homes or psychiatric institutions. The mean survival time for the 269 patients discharged from hospital alive was 6.13 years. 110 patients were alive after five and 61 after 10 years. The cost per patient discharged alive was 40,642 or 6,632 per life year gained.


CONCLUSIONS
Cardiac arrest patients do not occupy intensive care beds too long, and few end up in a vegetative state. Methodological differences in different studies makes meaningful comparisons of costs difficult, but the costs per life year saved are not high compared to other publications.
Center for Medical Ethics, University of Oslo, Oslo, Norway. anns@uus.no
Anne-Cathrine
AC
Naess
Petter Andreas
PA
Steen
D022561:Advanced Cardiac Life Support / Q000191:economics; D000368:Aged; D000552:Ambulances / Q000191:economics; D003325:Coronary Care Units / Q000191:economics; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006323:Heart Arrest / Q000191:economics / Q000628:therapy*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D009664:Norway; D009735:Nursing Homes / Q000191:economics; D010351:Patient Discharge; D019057:Quality-Adjusted Life Years; D012046:Rehabilitation / Q000191:economics; D012151:Resuscitation / Q000191:economics*; D015996:Survival Rate