Cost-effectiveness of automated external defibrillator deployment in selected public locations
- 1 September 2003
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 18 (9), 745-754
- https://doi.org/10.1046/j.1525-1497.2003.21139.x
Abstract
OBJECTIVE: The American Heart Association (AHA) recommends an automated external defibrillator (AED) be considered for a specific location if there is at least a 20% annual probability the device will be used. We sought to evaluate the cost-effectiveness of the AHA recommendation and of AED deployment in selected public locations with known cardiac arrest rates. DESIGN: Markov Decision Model employing a societal perspective. SETTING: Selected public locations in the United States. PATIENTS: A simulated cohort of the American public. INTERVENTION: Strategy 1: individuals experiencing cardiac arrest were treated by emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals were treated with AEDs deployed as part of a public access defibrillation program. Strategies differed only in the initial availability of an AED and its impact on cardiac arrest survival. RESULTS: Under the base-case assumption that a deployed AED will be used on 1 cardiac arrest every 5 years (20% annual probability of AED use), the cost per quality-adjusted life year (QALY) gained is $30,000 for AED deployment compared with EMS-D care. AED deployment costs less than $50,000 per QALY gained provided that the annual probability of AED use is 12% or greater. Monte Carlo simulation conducted while holding the annual probability of AED use at 20% demonstrated that 87% of the trials had a cost-effectiveness ratio of less than $50,000 per QALY. CONCLUSIONS: AED deployment is likely to be cost-effective across a range of public locations. The current AHA guidelines are overly restrictive. Limited expansion of these programs can be justified on clinical and economic grounds.Keywords
This publication has 39 references indexed in Scilit:
- The Impact of Including Passive Benefits in Cost-Effectiveness Analysis: The Case of Automated External Defibrillators on Commercial AircraftValue in Health, 2003
- Cost-Effectiveness of the Implantable Cardioverter-Defibrillator Versus Antiarrhythmic Drugs in Survivors of Serious Ventricular TachyarrhythmiasCirculation, 2002
- T HE L OCATIONS OF N ONRESIDENTIAL O UT-OF -H OSPITAL C ARDIAC A RRESTS IN THE C ITY OF P ITTSBURGH OVER A T HREE-YEAR P ERIOD : I MPLICATIONS FOR A UTOMATED E XTERNAL D EFIBRILLATOR P LACEMENTPrehospital Emergency Care, 2001
- A UTOMATED E XTERNAL D EFIBRILLATORS IN L ONG-TERM C ARE F ACILITIES ARE C OST-EFFECTIVEPrehospital Emergency Care, 2000
- C OST -E FFECTIVENESS A NALYSIS OF A R URAL /U RBAN F IRST - RESPONDER D EFIBRILLATION P ROGRAMPrehospital Emergency Care, 2000
- Probabilistic Sensitivity Analysis Incorporating the BootstrapMedical Decision Making, 1999
- Multi-Attribute Preference FunctionsPharmacoEconomics, 1995
- Outcome of CPR in a large metropolitan area — where are the survivors?Annals of Emergency Medicine, 1991
- EuroQol - a new facility for the measurement of health-related quality of lifeHealth Policy, 1990
- Probabilistic Sensitivity Analysis Using Monte Carlo SimulationMedical Decision Making, 1985