Cost-Effectiveness of Lay Responder Defibrillation for Out-of-Hospital Cardiac Arrest - 14/09/13
, Ella Huszti, MSc b, Alice Birnbaum, MA c, Brian Mahoney, MD d, Myron Weisfeldt, MD e, Andrew Travers, MD f, Jim Christenson, MD g, Karen Kuntz, ScD hPAD Investigators
Address for reprints: Graham Nichol, MD, University of Washington Harborview Center for Prehospital Emergency Care, Box 359727, 325 Ninth Avenue, Seattle, WA 98104; 206-521-1728, Fax 206-521-1784Résumé |
Study objective |
Our objective is to evaluate the incremental cost-effectiveness of use of cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) by lay responders (CPR+AED) versus CPR only for cardiac arrest during a multicenter randomized trial.
Methods |
This was a prospective trial from July 2000 to September 2003 that randomly assigned 993 community units (eg, office buildings, public areas) in 24 sites to an emergency response system, using lay volunteers trained in CPR only or CPR+AED. Cost and quality of life data were collected with effectiveness data. The primary analysis evaluated the incremental cost-effectiveness of defibrillator use in public locations by using Markov modeling.
Results |
CPR only had 14 survivors to discharge and CPR+AED had 29. CPR only had a mean of 0.58 (95% confidence interval [CI] 0.28 to 0.88) quality-adjusted life-years and a mean $42,400 (95% CI $22,100 to $62,600) costs. CPR+AED had mean 1.14 (95% CI 0.44 to 1.83) quality-adjusted life-years, mean $68,400 (95% CI $28,300 to $108,400) costs, and a long-term cost of mean $46,700 (95% CI $23,100 to $68,600) per quality-adjusted life-year. Results were sensitive to the effectiveness of the intervention, time horizon, location of arrest, and other factors.
Conclusion |
Training and equipping lay volunteers to defibrillate in public places may have an incremental cost-effectiveness that is similar to that of other common health interventions.
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| Supervising editor: Theodore R. Delbridge, MD, MPH |
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| Author contributions: GN, EH, and KK conceived the study, designed the trial, and obtained research funding. GN, EH, and AB supervised the conduct of the trial and data collection. AB undertook recruitment of participating centers and patients and managed the data, including quality control. EH, AB, and KK provided statistical advice on study design and analyzed the data. GN drafted the article, and all authors contributed substantially to its revision. GN takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. For full disclosures, see Appendix E2, available at www.annemergmed.com. |
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| Publication date: Available online March 25, 2009. |
Vol 54 - N° 2
P. 226 - août 2009 Retour au numéro
Article précédent
- Safety and Efficacy of Rapid Titration Using 1mg Doses of Intravenous Hydromorphone in Emergency Department Patients With Acute Severe Pain: The “1+1” Protocol
- Andrew K. Chang, Polly E. Bijur, Caron M. Campbell, Mary K. Murphy, E. John Gallagher
- Lay Responder Defibrillation, Pancake Breakfasts, and Survival From Out-of-Hospital Cardiac Arrest
- Daniel W. Spaite
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