Cost effectiveness of defibrillation by targeted responders in public settings

[摘要] Background-Out-of-hospital cardiac arrest is frequent and has poor outcomes. Defibrillation by trained targeted nontraditional responders improves survival versus historical controls, but it is unclear whether such defibrillation is a good value for the money. Therefore, this study estimated the incremental cost effectiveness of defibrillation by targeted nontraditional responders in public settings by using decision analysis. Methods and Results-A Markov model evaluated the potential cost effectiveness of standard emergency medical services ( EMS) versus targeted nontraditional responders. Standard EMS included first-responder defibrillation followed by advanced life support. Targeted nontraditional responders included standard EMS supplemented by defibrillation by trained lay responders. The analysis adopted a US societal perspective. Input data were derived from published or publicly available data. Future costs and effects were discounted at 3%. Monte Carlo simulation and sensitivity analyses assessed the robustness of results. Standard EMS had a median of 0.47 (interquartile range [IQR] = 0.32 to 0.69) quality-adjusted life years and a median of $14 100 (IQR = $8600 to $21 900) costs per arrest. Targeted nontraditional responders in casinos had an incremental cost of a median $56 700 (IQR = $44 100 to $77 200) per additional quality-adjusted life year. The results were sensitive to changes in time to defibrillation, incidence of arrest, and number of devices required to implement rapid defibrillation. Conclusions-Where cardiac arrest is frequent and response time intervals are short, rapid defibrillation by targeted nontraditional responders may be a good value for the money compared with standard EMS. The incidence of arrest should be considered when choosing locations to implement public access defibrillation.

[效力级别]  Proceedings Paper

[关键词] IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR;EMERGENCY MEDICAL-SERVICES;HEART-ASSOCIATION REPORT;CARDIAC-ARREST;ACCESS DEFIBRILLATION;RESUSCITATION;METAANALYSIS;UNCERTAINTY;PREVENTION;SURVIVAL