Cost-effectiveness of public automated external defibrillators

Andersen, Lars W.; Holmberg, Mathias J.; Granfeldt, Asger; James, Lyndon; Caulley, Lisa

doi:10.1016/j.resuscitation.2019.03.029

Cited by 25 publications

(17 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These estimates underline the special cost-efficiency of EVapp to gain considerable QALY via a better use of yet available resources. Andersen et al extensively evaluated the sensitivity and cost-effectiveness of PAD in the US [19]. They demonstrated a cost of around 50 k€ QALY −1 from a societal perspective and 12 k€ QALY −1 from a healthcare perspective.…”

Section: Discussionmentioning

confidence: 99%

“…The model is still particularly interesting to compare survival for different scenarios, similar outside the response time of the interventions. Previous studies have been conducted on the clinical benefits and cost-effectiveness of public access defibrillation (PAD) programs, aimed at increasing the use of AED, prior to EMS-arrival [19,20]. Comparison of such programs is challenging, considering the high degree of heterogeneity in the types of programs implemented (e.g., static vs mobile AED use, strategy for activation, defibrillation by professionals, the public, or combinations of both) and the context within which they operate (baseline availability of public AED, overall chain of survival and level of care, geographic variations, socio-economic disparities) [20,21].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium

Vercammen¹,

Moens

2020

Cost Eff Resour Alloc

View full text Add to dashboard Cite

Background EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. Methods An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. Results Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1. Conclusions EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium

Vercammen¹,

Moens

2020

Cost Eff Resour Alloc

View full text Add to dashboard Cite

show abstract

“…The assumption that neurological function cannot improve or deteriorate after the first year post cardiac arrest was made because of a lack of robust data to estimate the between-state transitions, and is consistent with recent economic models evaluating the cost-effectiveness of intervention in cardiac arrest. 159 Patients in the OHCA state were assigned cost and utility values obtained from the within-trial sensitivity analysis in which the time horizon was extended to 1 year. This covered the full spectrum of costs and QALYs incurred in the first year after the cardiac arrest event, adjusted for demographic and clinical characteristics.…”

Section: Extrapolating Beyond Trial Follow-upmentioning

confidence: 99%

“…An economic model for publicaccess defibrillation reported an ICER of US$53,797 per QALY gained. 159 An economic evaluation of a mechanical chest compression device found that manual CPR dominated in health economic terms (mechanical CPR cost more and led to a reduction in QALYs, on average). 136 An extracorporeal CPR strategy in Sydney reported an ICER of €16,890 per QALY gained.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT

Perkins

Achana

et al. 2021

Health Technol Assess

View full text Add to dashboard Cite

Background Adrenaline has been used as a treatment for cardiac arrest for many years, despite uncertainty about its effects on long-term outcomes and concerns that it may cause worse neurological outcomes. Objectives The objectives were to evaluate the effects of adrenaline on survival and neurological outcomes, and to assess the cost-effectiveness of adrenaline use. Design This was a pragmatic, randomised, allocation-concealed, placebo-controlled, parallel-group superiority trial and economic evaluation. Costs are expressed in Great British pounds and reported in 2016/17 prices. Setting This trial was set in five NHS ambulance services in England and Wales. Participants Adults treated for an out-of-hospital cardiac arrest were included. Patients were ineligible if they were pregnant, if they were aged < 16 years, if the cardiac arrest had been caused by anaphylaxis or life-threatening asthma, or if adrenaline had already been given. Interventions Participants were randomised to either adrenaline (1 mg) or placebo in a 1 : 1 allocation ratio by the opening of allocation-concealed treatment packs. Main outcome measures The primary outcome was survival to 30 days. The secondary outcomes were survival to hospital admission, survival to hospital discharge, survival at 3, 6 and 12 months, neurological outcomes and health-related quality of life through to 6 months. The economic evaluation assessed the incremental cost per quality-adjusted life-year gained from the perspective of the NHS and Personal Social Services. Participants, clinical teams and those assessing patient outcomes were masked to the treatment allocation. Results From December 2014 to October 2017, 8014 participants were assigned to the adrenaline (n = 4015) or to the placebo (n = 3999) arm. At 30 days, 130 out of 4012 participants (3.2%) in the adrenaline arm and 94 out of 3995 (2.4%) in the placebo arm were alive (adjusted odds ratio for survival 1.47, 95% confidence interval 1.09 to 1.97). For secondary outcomes, survival to hospital admission was higher for those receiving adrenaline than for those receiving placebo (23.6% vs. 8.0%; adjusted odds ratio 3.83, 95% confidence interval 3.30 to 4.43). The rate of favourable neurological outcome at hospital discharge was not significantly different between the arms (2.2% vs. 1.9%; adjusted odds ratio 1.19, 95% confidence interval 0.85 to 1.68). The pattern of improved survival but no significant improvement in neurological outcomes continued through to 6 months. By 12 months, survival in the adrenaline arm was 2.7%, compared with 2.0% in the placebo arm (adjusted odds ratio 1.38, 95% confidence interval 1.00 to 1.92). An adjusted subgroup analysis did not identify significant interactions. The incremental cost-effectiveness ratio for adrenaline was estimated at £1,693,003 per quality-adjusted life-year gained over the first 6 months after the cardiac arrest event and £81,070 per quality-adjusted life-year gained over the lifetime of survivors. Additional economic analyses estimated incremental cost-effectiveness ratios for adrenaline at £982,880 per percentage point increase in overall survival and £377,232 per percentage point increase in neurological outcomes over the first 6 months after the cardiac arrest. Limitations The estimate for survival with a favourable neurological outcome is imprecise because of the small numbers of patients surviving with a good outcome. Conclusions Adrenaline improved long-term survival, but there was no evidence that it significantly improved neurological outcomes. The incremental cost-effectiveness ratio per quality-adjusted life-year exceeds the threshold of £20,000–30,000 per quality-adjusted life-year usually supported by the NHS. Future work Further research is required to better understand patients’ preferences in relation to survival and neurological outcomes after out-of-hospital cardiac arrest and to aid interpretation of the trial findings from a patient and public perspective. Trial registration Current Controlled Trials ISRCTN73485024 and EudraCT 2014-000792-11. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 25. See the NIHR Journals Library website for further project information.

show abstract

“…A recent review found cost-effectiveness ratios between 37 200 and 1 152 400 US dollars/quality-adjusted life-years. 185 Another recent cost-effectiveness analysis study 218 from the United States concluded that public access AEDs are a cost-effective public health intervention.…”

Section: Defibrillationmentioning

confidence: 99%

Adult Basic Life Support

Berg¹,

Soar²,

Andersen³

et al. 2020

Resuscitation

100

View full text Add to dashboard Cite

This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 20 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 3 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.

show abstract

Cost-effectiveness of public automated external defibrillators

Cited by 25 publications

References 31 publications

Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium

Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium

Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT

Adult Basic Life Support

Contact Info

Product

Resources

About