title: Cost-effectiveness of a national public access defibrillation programme.
abstract: OBJECTIVE
  Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement.
  
  
  METHODS
  We used a cost-utility analysis to estimate the costs and consequences of public access defibrillation (PAD) programmes from a societal perspective, based on AED deployment by building type. Comparator programmes ranged from those that only included building types with the highest incidence of OHCA, to the comprehensive programme outline in the proposed legislation. Data on OHCA incidence and outcomes were obtained from the Irish Out-of-Hospital-Cardiac-Arrest Register (OHCAR). Costs were obtained from the Irish health service, device suppliers and training providers.
  
  
  RESULTS
  The incremental cost effectiveness ratio (ICER) for the most comprehensive PAD scheme was €928,450/QALY. The ICER for the most scaled-back programme involving AED placement in transport stations, medical practices, entertainment venues, schools (excluding primary) and fitness facilities was €95,640/QALY. A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective.
  
  
  CONCLUSIONS
  National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.
authors.affiliation: Department of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland; Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland. Electronic address: moranps@tcd.ie.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Moran
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
authors.forename: Conor
authors.initials: C
authors.lastname: Teljeur
authors.affiliation: Discipline of General Practice, National University of Ireland Galway, Ireland; Department of Public Health Medicine, Health Service Executive, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland.
authors.forename: Siobhán
authors.initials: S
authors.lastname: Masterson
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
authors.forename: Michelle
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Harrington
authors.affiliation: Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
authors.forename: Máirín
authors.initials: M
authors.lastname: Ryan
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D047548:Defibrillators / Q000191:economics / Q000600:supply & distribution*; D004554:Electric Countershock / Q000191:economics / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
keywords: Cost-effectiveness; Out-of-hospital cardiac arrest; Public access defibrillation