Assessing automated external defibrillators in preventing deaths from sudden cardiac arrest: an economic evaluation.
OBJECTIVE
The aim of this study was to evaluate the cost-effectiveness of on-site automated external defibrillators (AEDs) in the initial management of cardiac arrest in Ontario.


METHODS
This was a cost-effectiveness analysis based on published literature and data from the Canadian Institute of Health Information. The participants were fictitious male and female cardiac arrest patients who were initially managed with on-site AEDs, compared with similar patients managed without on-site AEDs. This group included a subgroup of high-risk patients (i.e., heart failure and left ventricular ejection fraction<35 percent). The analysis was conducted in a variety of settings including hospitals and homes in Ontario, Canada. The main outcome evaluated was cost per quality-adjusted life-year (QALY) gained from a payer's perspective.


RESULTS
Cost per QALY (all costs reported in Canadian dollars) was $12,768 when AEDs were deployed in hospitals, $511,766 when deployed in office buildings, $2,360,023 when deployed in apartment buildings, $87,569 when deployed in homes of high-risk patients, and $1,529,371 when deployed in homes of people older than 55 years of age.


CONCLUSIONS
Indiscriminate deployment of AEDs is not a cost-effective means of improving health outcomes of cardiac arrest. Their use should be restricted to emergency response programs, high-risk sites (such as hospitals), and high-risk patients.
Sharieff
Waseem
W
Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. doc.sharieff@utoronto.ca
Kaulback
Kellee
K
D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D017059:Models, Econometric; D009864:Ontario; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results