Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema.
OBJECTIVE
To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system.


METHODS
Using estimates from published reports on prehospital and emergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate and multivariate sensitivity analyses was performed on the input variables.


RESULTS
The cost of consumables, equipment, and training yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients and is expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications and reduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions.


CONCLUSIONS
Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.
Hubble
Michael W
MW
Emergency Medical Care Program, Western Carolina University, Cullowhee, North Carolina 28723, USA. mhubble@email.wcu.edu
Richards
Michael E
ME
Wilfong
Denise A
DA
D000208:Acute Disease; D045422:Continuous Positive Airway Pressure / Q000191:economics*; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000191:economics*; D004634:Emergency Medical Technicians; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D017059:Models, Econometric; D015999:Multivariate Analysis; D011654:Pulmonary Edema / Q000191:economics / Q000628:therapy*; D014481:United States; D019037:Urban Health Services