Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-17T08:55:26.700Z Has data issue: false hasContentIssue false

Assessing automated external defibrillators in preventing deaths from sudden cardiac arrest: An economic evaluation

Published online by Cambridge University Press:  19 June 2007

Waseem Sharieff
Affiliation:
University of Toronto and the Government of Ontario
Kellee Kaulback
Affiliation:
Government of Ontario

Abstract

Objectives: The aim of this study was to evaluate the cost-effectiveness of on-site automated external defibrillators (AEDs) in the initial management of cardiac arrest in Ontario.

Methods: This was a cost-effectiveness analysis based on published literature and data from the Canadian Institute of Health Information. The participants were fictitious male and female cardiac arrest patients who were initially managed with on-site AEDs, compared with similar patients managed without on-site AEDs. This group included a subgroup of high-risk patients (i.e., heart failure and left ventricular ejection fraction <35 percent). The analysis was conducted in a variety of settings including hospitals and homes in Ontario, Canada. The main outcome evaluated was cost per quality-adjusted life-year (QALY) gained from a payer's perspective.

Results: Cost per QALY (all costs reported in Canadian dollars) was $12,768 when AEDs were deployed in hospitals, $511,766 when deployed in office buildings, $2,360,023 when deployed in apartment buildings, $87,569 when deployed in homes of high-risk patients, and $1,529,371 when deployed in homes of people older than 55 years of age.

Conclusions: Indiscriminate deployment of AEDs is not a cost-effective means of improving health outcomes of cardiac arrest. Their use should be restricted to emergency response programs, high-risk sites (such as hospitals), and high-risk patients.

Type
GENERAL ESSAYS
Copyright
© 2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Heart Association 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. 2005 Part 5. Electrical therapies. Automated external defibrillators, defibrillation, cardioversion, and pacing. Circulation. 112: 3546.
Anonymous. 2003 Automated external defibrillators (AEDs). Health Devices. 32: 223234.
Bardy GH, Lee KL, Mark DB, et al. 2005 Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 352: 225237.Google Scholar
Cram P, Vijan S, Fendrick AM. 2003 Cost-effectiveness of automated external defibrillator deployment in selected public locations. J Gen Intern Med. 18: 745754.Google Scholar
Cram P, Vijan S, Katz D, et al. 2005 Cost-effectiveness of in-home automated external defibrillators for individuals at increased risk of sudden cardiac death: There's no place like home? J Gen Intern Med. 20: 251258.Google Scholar
De Maio VJ, Stiell IG, Wells GA, et al. 2003 Optimal defibrillation response intervals for maximum out-of-hospital cardiac arrest survival rates. Ann Emerg Med. 42: 242250.Google Scholar
Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. 1996. Cost-effectiveness in health and medicine. New York, NY: Oxford University Press;
Larsen MP, Eisenberg MS, Cummins RO, et al. 1993 Predicting survival from out-of-hospital cardiac arrest: A graphic model. Ann Emerg Med. 22: 16521658.Google Scholar
Mancini ME, Kaye W. 1998 In-hospital first-responder automated external defibrillation: What critical care practitioners need to know. Am J Crit Care. 7: 314319.Google Scholar
Manuel DG, Goel V, Williams JI. 1998 The derivation of life tables for local areas. Chronic Dis Can. 19: 5256.Google Scholar
Nichol G, Stiell IG, Hebert P, et al. 1999 What is the quality of life of survivors of cardiac arrest? A prospective study. Acad Emerg Med. 6: 95102.Google Scholar
Nichol G, Valenzuela T, Roe D, et al. 2003 Cost effectiveness of defibrillation by targeted responders in public settings. Circulation. 108: 697703.Google Scholar
Simpson CS, O'Neill BJ, Sholdice MM, et al. 2005 Canadian Cardiovascular Society commentary on implantable cardioverter defibrillators in Canada: Waiting times and access to care issues. Can J Cardiol. 21: 1924.Google Scholar
Statistics Canada. Tables by province or territory: Ontario. Available at: http://www40.statcan.ca/l01/pro01/pro106.htm. Accessed 21 July 2006.
Stiell IG, Wells GA, De Maio VJ, et al. 1999 Modifiable factors associated with improved cardiac arrest survival in a multicenter basic life support/defibrillation system: OPALS Study Phase I results. Ontario Prehospital Advanced Life Support. Ann Emerg Med. 33: 4450.Google Scholar
Stiell IG, Wells GA, Field BJ, et al. 1999 Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA. 281: 11751181.Google Scholar
Stiell IG, Wells GA, Spaite DW, et al. 1998 The Ontario Prehospital Advanced Life Support (OPALS) Study: Rationale and methodology for cardiac arrest patients. Ann Emerg Med. 32: 180190.Google Scholar
Vaillancourt C, Stiell IG, Canadian Cardiovascular Outcomes Research Team. 2004 Cardiac arrest care and emergency medical services in Canada. Can J Cardiol. 20: 10811090.Google Scholar