Cost-Effectiveness of Lay Responder Defibrillation for Out-of-Hospital Cardiac Arrest

Graham Nichol, Ella Huszti, Alice Birnbaum, Brian Mahoney, Myron Weisfeldt, Andrew Travers, Jim Christenson, Karen Kuntz

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume54
Issue number2
DOIs
StatePublished - Aug 2009

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Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Cost-Benefit Analysis
Defibrillators
Quality-Adjusted Life Years
Confidence Intervals
Costs and Cost Analysis
Volunteers
Heart Arrest
Multicenter Studies
Survivors
Emergencies
Quality of Life

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Cost-Effectiveness of Lay Responder Defibrillation for Out-of-Hospital Cardiac Arrest. / Nichol, Graham; Huszti, Ella; Birnbaum, Alice; Mahoney, Brian; Weisfeldt, Myron; Travers, Andrew; Christenson, Jim; Kuntz, Karen.

In: Annals of Emergency Medicine, Vol. 54, No. 2, 08.2009.

Research output: Contribution to journalArticle

Nichol, Graham ; Huszti, Ella ; Birnbaum, Alice ; Mahoney, Brian ; Weisfeldt, Myron ; Travers, Andrew ; Christenson, Jim ; Kuntz, Karen. / Cost-Effectiveness of Lay Responder Defibrillation for Out-of-Hospital Cardiac Arrest. In: Annals of Emergency Medicine. 2009 ; Vol. 54, No. 2.
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abstract = "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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