title: Cost-effectiveness analysis of alternative cooling strategies following cardiac arrest.
abstract: OBJECTIVE
  Using survival and neurologic outcome as endpoints , this study explored the incremental cost effectiveness of three mutually exclusive cooling strategies employed after resuscitated out-of-hospital cardiac arrests.
  
  
  METHODS
  Economic analysis based on retrospective data collection and Markov modeling.
  
  
  METHODS
  Modeling based on patients housed in a tertiary ICU setting.
  
  
  METHODS
  Patients >18 years following resuscitation from out-of-hospital cardiac arrest.
  
  
  METHODS
  Therapeutic cooling vs. conventional care.
  
  
  RESULTS
  Using societal-based analytic decision modeling with a lifetime study horizon, incremental cost effectiveness ratios (ICERs) for blanket, peritoneal lavage, and V-V ECMO cooling strategies were compared with conventional care. Comprehensive cost data were obtained from available literature, national and local databases; health utility data were abstracted from previous publications and converted to quality-adjusted life years (QALYs)/person and stratified by neurologic outcome state. Future costs were discounted using a standard 3% discount rate. Cooling blankets produced better overall health outcomes at a lower cost than conventional care and V-V ECMO. Peritoneal lavage added an additional 0.67 QALYs at an ICER of $58,329/QALY. Monte-Carlo simulations incorporating uncertainty in all parameters showed that peritoneal lavage was 70% likely to be the preferred, cost-effective therapy if one were willing to pay (WTP) $100,000/QALY.
  
  
  CONCLUSIONS
  This analysis suggests that blankets are the most cost effective cooling strategy for post-ROSC therapeutic hypothermia, with peritoneal lavage as an acceptable alternative at higher WTP thresholds. Though uncertainty about the optimal therapy could be reduced with additional research, these results can inform policy-makers and healthcare providers about cost effectiveness of alternative cooling modalities designed to improve neurologic outcome for this expanding patient population. This may be particularly relevant as societal-based cost effectiveness analyses become more widely incorporated into studies evaluating treatment for frequently encountered diseases.
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, 1540 E. Medical Center Dr. Floor 11, Rm 715Z, Ann Arbor, MI 48109 USA ; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA.
authors: Robert J
authors: RJ
authors: Gajarski
authors: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA.
authors: Kurtis
authors: K
authors: Smitko
authors: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA.
authors: Renee
authors: R
authors: Despres
authors: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA.
authors: Jeff
authors: J
authors: Meden
authors: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA.
authors: David W
authors: DW
authors: Hutton
keywords: Cardiac arrest; Cost effectiveness; Decision analysis; Markov modeling; Neurologic outcome; Therapeutic hypothermia