The cost-effectiveness of a mechanical compression device in out-of-hospital cardiac arrest

RESUSCITATION

卷:117

Article

Marti, Joachim¹  Hulme, Claire²  Ferreira, Zenia²  Nikolova, Silviya²  Lall, Ranjit³  Kaye, Charlotte³  Smyth, Michael^3,8  Kelly, Charlotte²  Quinn, Tom⁴  Gates, Simon³  Deakin, Charles D.^5,6  Perkins, Gavin D.^3,7 

[1] Imperial Coll London, Inst Global Hlth Innovat, Ctr Hlth Policy, St Marys Campus,10th Floor QEQM Bldg,2 Praed St, London W2 1NY, England

[2] Univ Leeds, Acad Unit Hlth Econ, Charles Thackrah Bldg,101 Clarendon Rd, Leeds LS2 9LJ, W Yorkshire, England

[3] Univ Warwick, Warwick Clin Trials Unit, Coventry CV4 7AL, W Midlands, England

[4] Univ London, Kingston Univ London & St Georges, Fac Hlth Social Care & Educ, London SW17 0RE, England

[5] South Cent Ambulance Serv NHS Fdn Trust, Otterbourne SO21 2RU, England

[6] Univ Hosp Southampton, Resp BRU, Southampton SO16 6YD, Hants, England

[7] Heart England NHS Fdn Trust, Bordesley Green, Birmingham B9 5SS, W Midlands, England

[8] West Midlands Ambulance Serv NHS Fdn Trust, Brierley Hill DY5 1LX, W Midlands, England

关键词: Cardiac arrest;    Mechanical compression;    Cost-effectiveness;    Health economics;   

DOI  :  10.1016/j.resuscitation.2017.04.036

来源: Elsevier

【 摘 要 】

Aim: To assess the cost-effectiveness of LUCAS-2, a mechanical device for cardiopulmonary resuscitation (CPR) as compared to manual chest compressions in adults with non-traumatic, out-of-hospital cardiac arrest. Methods: We analysed patient-level data from a large, pragmatic, multi-centre trial linked to administrative secondary care data from the Hospital Episode Statistics (HES) to measure healthcare resource use, costs and outcomes in both arms. A within-trial analysis using quality adjusted life years derived from the EQ-5D-3L was conducted at 12-month follow-up and results were extrapolated to the lifetime horizon using a decision-analytic model. Results: 4471 patients were enrolled in the trial (1652 assigned to the LUCAS-2 group, 2819 assigned to the control group). At 12 months, 89 (5%) patients survived in the LUCAS-2 group and 175 (6%) survived in the manual CPR group. In the vast majority of analyses conducted, both within-trial and by extrapolation of the results over a lifetime horizon, manual CPR dominates LUCAS-2. In other words, patients in the LUCAS-2 group had poorer health outcomes (i.e. lower QALYs) and incurred higher health and social care costs. Conclusion: Our study demonstrates that the use of the mechanical chest compression device LUCAS-2 represents poor value for money when compared to standard manual chest compression in out-of-hospital cardiac arrest. (C) 2017 Elsevier B.V. All rights reserved.

【 授权许可】

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