Cost effectiveness of defibrillation by targeted responders in public settings

Article; Proceedings Paper

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

DOI  :  10.1161/01.CIR.0000084545.65645.28

来源: SCIE

【 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.

【 授权许可】

Free