Health System Costs of Out-of-Hospital Cardiac Arrest in Relation to Time to Shock
- 5 October 2004
- journal article
- research article
- Published by Wolters Kluwer Health in Circulation
- Vol. 110 (14) , 1967-1973
- https://doi.org/10.1161/01.cir.0000143150.13727.19
Abstract
Background— Early defibrillation results in higher admission rates and healthcare costs. This study determined the healthcare resources used and related medical costs after out-of-hospital cardiac arrest (OHCA) in relation to time to shock. We assessed the incremental healthcare costs per life gained from reduction in time to shock of 2, 4, and 6 minutes. Methods and Results— Clinical and costs data of patients in witnessed OHCA with ventricular fibrillation as initial rhythm were collected. Each patient’s time to shock was estimated and assigned to 1 of 3 categories: ≤7 minutes (early), 7 to 12 minutes (intermediate), and >12 minutes (late). Incremental cost-effectiveness analysis and Monte Carlo simulation compared scenarios of reduction in time to shock of 2, 4, and 6 minutes. Six-month survival was 22%. Mean prehospital, in-hospital, and posthospital costs in the first half-year after OHCA were €559, €6869 and €666. Mean costs were €28 636 per survivor and €2384 per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging €20 253. Of the intermediate group (n=149), 26% survived, with costs averaging €31 467. Among patients shocked late (n=135), 13% survived, with costs averaging €27 781. The point estimates of the incremental cost-effectiveness ratios of reduction of time to shock of 2, 4, and 6 minutes compared with baseline were €17 508, €14 303, and €12 708 per life saved, respectively. Conclusions— Costs per survivor were lowest with the shortest time to shock because of shorter stay in the intensive care unit. Reducing the time to defibrillation increases the healthcare costs by an acceptable amount according to current standards and is economically attractive.Keywords
This publication has 21 references indexed in Scilit:
- Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trialBMJ, 2003
- Health-Related Quality of Life Is Better for Cardiac Arrest Survivors Who Received Citizen Cardiopulmonary ResuscitationCirculation, 2003
- Cost Effectiveness of Defibrillation by Targeted Responders in Public SettingsCirculation, 2003
- Tripling Survival From Sudden Cardiac Arrest Via Early Defibrillation Without Traditional Education in Cardiopulmonary ResuscitationCirculation, 2002
- Impact of Community-Wide Police Car Deployment of Automated External Defibrillators on Survival From Out-of-Hospital Cardiac ArrestCirculation, 2002
- Estimated cost effectiveness of a police automated external defibrillator program in a suburban community:Resuscitation, 2002
- BAYESIAN COST-EFFECTIVENESS ANALYSISInternational Journal of Technology Assessment in Health Care, 2001
- Use of Automated External Defibrillators by a U.S. AirlineNew England Journal of Medicine, 2000
- Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in CasinosNew England Journal of Medicine, 2000
- C OST -E FFECTIVENESS A NALYSIS OF A R URAL /U RBAN F IRST - RESPONDER D EFIBRILLATION P ROGRAMPrehospital Emergency Care, 2000