- Link:
- http://hdl.handle.net/2027.42/72546
- Collection:
-
- Subjects
- emergency medical services heart arrest electric countershock public access defibrillation Internal Medicine and Specialties Health Sciences
- Creators:
- Fendrick, A. Mark Cram, Peter Vijan, Sandeep
- Contributor:
- Received from the Division of General Medicine,
Department of Internal Medicine (PC), University of Iowa College of
Medicine, Iowa City, Iowa and Division of General Medicine,
Department of Internal Medicine, University of Michigan School of
Medicine (SV
- Publisher
- Blackwell Science Inc
- Format
- 4750407 bytes
- Format
- 3109 bytes
- Format
- application/pdf
- Format
- text/plain
- Rights
- 2003 by the Society of General Internal Medicine
- Description
- 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.
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