title: Cost-effectiveness of lay responder defibrillation for out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  Our objective is to evaluate the incremental cost-effectiveness of use of cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) by lay responders (CPR+AED) versus CPR only for cardiac arrest during a multicenter randomized trial.
  
  
  METHODS
  This was a prospective trial from July 2000 to September 2003 that randomly assigned 993 community units (eg, office buildings, public areas) in 24 sites to an emergency response system, using lay volunteers trained in CPR only or CPR+AED. Cost and quality of life data were collected with effectiveness data. The primary analysis evaluated the incremental cost-effectiveness of defibrillator use in public locations by using Markov modeling.
  
  
  RESULTS
  CPR only had 14 survivors to discharge and CPR+AED had 29. CPR only had a mean of 0.58 (95% confidence interval [CI] 0.28 to 0.88) quality-adjusted life-years and a mean $42,400 (95% CI $22,100 to $62,600) costs. CPR+AED had mean 1.14 (95% CI 0.44 to 1.83) quality-adjusted life-years, mean $68,400 (95% CI $28,300 to $108,400) costs, and a long-term cost of mean $46,700 (95% CI $23,100 to $68,600) per quality-adjusted life-year. Results were sensitive to the effectiveness of the intervention, time horizon, location of arrest, and other factors.
  
  
  CONCLUSIONS
  Training and equipping lay volunteers to defibrillate in public places may have an incremental cost-effectiveness that is similar to that of other common health interventions.
authors.affiliation: University of Washington, Seattle, WA, USA. nichol@u.washington.edu
authors.forename: Graham
authors.initials: G
authors.lastname: Nichol
authors.forename: Ella
authors.initials: E
authors.lastname: Huszti
authors.forename: Alice
authors.initials: A
authors.lastname: Birnbaum
authors.forename: Brian
authors.initials: B
authors.lastname: Mahoney
authors.forename: Myron
authors.initials: M
authors.lastname: Weisfeldt
authors.forename: Andrew
authors.initials: A
authors.lastname: Travers
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
authors.forename: Karen
authors.initials: K
authors.lastname: Kuntz