Cost-effectiveness of in-home automated external defibrillators for individuals at increased risk of sudden cardiac death.
OBJECTIVE
In-home automated external defibrillators (AEDs) are increasingly recommended as a means for improving survival of cardiac arrests that occur at home. The current study was conducted to explore the relationship between individuals' risk of cardiac arrest and cost-effectiveness of in-home AED deployment.


METHODS
Markov decision model employing a societal perspective.


METHODS
Four hypothetical cohorts of American adults 60 years of age at progressively greater risk for sudden cardiac death (SCD): 1) all adults (annual probability of SCD 0.4%); 2) adults with multiple SCD risk factors (probability 2%); 3) adults with previous myocardial infarction (probability 4%); and 4) adults with ischemic cardiomyopathy unable to receive an implantable defibrillator (probability 6%).


METHODS
Strategy 1: individuals suffering an in-home cardiac arrest were treated with emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals suffering an in-home cardiac arrest received initial treatment with an in-home AED, followed by EMS.


RESULTS
Assuming cardiac arrest survival rates of 15% with EMS-D and 30% with AEDs, the cost per quality-adjusted life-year gained (QALY) of providing in-home AEDs to all adults 60 years of age is 216,000 dollars. Costs of providing in-home AEDs to adults with multiple risk factors (2% probability of SCD), previous myocardial infarction (4% probability), and ischemic cardiomyopathy (6% probability) are 132,000 dollars, 104,000 dollars, and 88,000 dollars, respectively.


CONCLUSIONS
The cost-effectiveness of in-home AEDs is intimately linked to individuals' risk of SCD. However, providing in-home AEDs to all adults over age 60 appears relatively expensive.
Cram
Peter
P
Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA. peter-cram@uiowa.edu <peter-cram@uiowa.edu>
Vijan
Sandeep
S
Katz
David
D
Fendrick
A Mark
AM
D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D047548:Defibrillators / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics; D006699:Home Care Services / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States