title: Cost-utility analysis of treating out of hospital cardiac arrests in Jerusalem.
abstract: BACKGROUND
  Out-of-hospital cardiac arrest (OHCA) initiates a chain of responses including emergency medical service mobilization and medical treatment, transfer and admission first to a hospital Emergency Department (ED) and then usually to an intensive care unit and ward. Costly pre- and in-hospital care may be followed by prolonged post discharge expenditure on treatment of patients with severe neurological sequelae. We assessed the cost-effectiveness of treatment of OHCA by calculating the cost per Disability Adjusted Life Year (DALY) averted.
  
  
  RESULTS
  We studied 3355 consecutive non-traumatic OHCAs (2005-2010) in Jerusalem, Israel, supplemented by hospital utilization data extracted from patient files (n = 570) and post-discharge follow-up (n = 196). Demographic, utilization and economic data were incorporated into a spreadsheet model to calculate the cost-utility ratio. Advanced life support was administered to 2264 of the 3355 OHCAs (67.5%) and 1048 (45.6%) patients were transferred to the ED. Of 676 (20.1%) patients who survived the ED and were admitted, there were 206 (6.1%) survivors to discharge, among them only 113 (3.4%) neurologically intact. Total cost ($39,100,000) per DALY averted (1353) was $28,864.
  
  
  CONCLUSIONS
  The current package of OHCA interventions in Jerusalem appears to be very cost-effective as the cost per averted DALY of $28,864 is less than the Gross Domestic Product per capita ($33,261). This paper provides a basis for studying the effects of potential interventions that can be evaluated in terms of their incremental costs per averted DALY for treatment of OHCA.
authors.affiliation: Department of Technology Assessment, Israel Ministry of Health, Jerusalem, Israel. Electronic address: gary.ginsberg@moh.health.gov.il.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Ginsberg
authors.affiliation: Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
authors.affiliation: Intensive Care Unit, Shaare Zedek Medical Centre and Hebrew University, School of Medicine, Jerusalem, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000191:economics* / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D055815:Young Adult
keywords: Cardiopulmonary resuscitation; Cost–utility analysis; Heart arrest