From Loeb Medical Research Institute, University of Ottawa, Canada;
University of Washington, Seattle; Department of Emergency Medicine, Medical
College of Virginia, Richmond; San Diego State University, San Diego;
Department of Emergency Medicine, University of Arizona, Tucson; Mayo Clinic,
Rochester, Minn; and Department of Medicine, Columbia-Presbyterian Medical
Center, New York, NY.
Correspondence to Graham Nichol, MD, Clinical Epidemiology Unit F-6, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
Background—Approximately 360 000
Americans experience sudden cardiac arrest each year; current
treatments are expensive and not very effective. Public access
defibrillation (PAD) is a novel treatment for out-of-hospital sudden
cardiac arrest that refers to use of automated external defibrillators
by the lay public or by nonmedical personnel such as police. A clinical
trial has been proposed to evaluate the effectiveness of public access
defibrillation, but it is unclear whether such early defibrillation
will offer sufficient value for money. Our objective was to estimate
the potential cost-effectiveness of public access defibrillation by use
of decision analysis.
Methods and Results—A decision model compared the potential
cost-effectiveness of standard emergency medical services (EMS) systems
with that of EMS supplemented by PAD. We considered defibrillation by
lay responders or police, using an analysis with a US
health-care perspective. Input data were derived from published data or
fiscal databases. Future costs and effects were discounted at 3%.
Monte Carlo simulation was performed to estimate the variability in the
costs and effects of each program. Sensitivity analyses
assessed the robustness of the results to changes in input data. A
standard EMS system had a median cost of $5900 per cardiac arrest
patient (interquartile range, IQR, $3200 to $10 900) and yielded a
median of 0.25 quality-adjusted life years (IQR, 0.20 to 0.30). PAD by
lay responders had a median incremental cost of $44 000 per additional
quality-adjusted life year (IQR, $29 000 to $68 900). PAD by police
had a median incremental cost of $27 200 per additional
quality-adjusted life year (IQR, $15 700 to $47 800). The results
were sensitive to changes in the cost and relative survival benefit of
PAD.
Conclusions—Although more expensive than standard EMS for sudden
cardiac arrest, PAD may be economically attractive. The effectiveness
and cost-effectiveness of PAD should be assessed in a randomized,
controlled trial.
© 1998 American Heart Association, Inc.
Special Reports
Potential Cost-effectiveness of Public Access Defibrillation in the United States
Key Words: cost-benefit analysis • heart-assist device • heart arrest
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