Health system costs of out-of-hospital cardiac arrest in relation to time to shock.
BACKGROUND
Early defibrillation results in higher admission rates and healthcare costs. This study determined the healthcare resources used and related medical costs after out-of-hospital cardiac arrest (OHCA) in relation to time to shock. We assessed the incremental healthcare costs per life gained from reduction in time to shock of 2, 4, and 6 minutes.


RESULTS
Clinical and costs data of patients in witnessed OHCA with ventricular fibrillation as initial rhythm were collected. Each patient's time to shock was estimated and assigned to 1 of 3 categories: < or =7 minutes (early), 7 to 12 minutes (intermediate), and >12 minutes (late). Incremental cost-effectiveness analysis and Monte Carlo simulation compared scenarios of reduction in time to shock of 2, 4, and 6 minutes. Six-month survival was 22%. Mean prehospital, in-hospital, and posthospital costs in the first half-year after OHCA were 559 Euros, 6869 Euros and 666 Euros. Mean costs were 28,636 Euros per survivor and 2384 Euros per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20,253 Euros. Of the intermediate group (n=149), 26% survived, with costs averaging 31,467 Euros. Among patients shocked late (n=135), 13% survived, with costs averaging 27,781 Euros. The point estimates of the incremental cost-effectiveness ratios of reduction of time to shock of 2, 4, and 6 minutes compared with baseline were 17,508 Euros, 14,303 Euros, and 12,708 Euros per life saved, respectively.


CONCLUSIONS
Costs per survivor were lowest with the shortest time to shock because of shorter stay in the intensive care unit. Reducing the time to defibrillation increases the healthcare costs by an acceptable amount according to current standards and is economically attractive.
van Alem
Anouk P
AP
Department of Cardiology, Academic Medical Center, Room F3-241, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. a.p.vanalem@amc.uva.nl.
Dijkgraaf
Marcel G W
MG
Tijssen
Jan G P
JG
Koster
Rudolph W
RW
D000368:Aged; D015331:Cohort Studies; D003325:Coronary Care Units / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D047548:Defibrillators / Q000191:economics / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000191:economics* / Q000209:etiology / Q000401:mortality / Q000451:nursing / Q000628:therapy; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications / Q000628:therapy*