Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 226-235.e2, August 2009

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

  • Graham Nichol, MD

      Affiliations

    • University of Washington, Seattle, WA
    • Corresponding Author InformationAddress for reprints: Graham Nichol, MD, University of Washington Harborview Center for Prehospital Emergency Care, Box 359727, 325 Ninth Avenue, Seattle, WA 98104; 206-521-1728, Fax 206-521-1784
    • ,
  • Ella Huszti, MSc

      Affiliations

    • McGill University, Montreal, Quebec, Canada
    • ,
  • Alice Birnbaum, MA

      Affiliations

    • Axio Research Inc., Seattle, WA
    • ,
  • Brian Mahoney, MD

      Affiliations

    • University of Minnesota, Minneapolis, MN
    • ,
  • Myron Weisfeldt, MD

      Affiliations

    • Johns Hopkins University, Baltimore, MD
    • ,
  • Andrew Travers, MD

      Affiliations

    • Dalhousie University, Halifax, Nova Scotia, Canada
    • ,
  • Jim Christenson, MD

      Affiliations

    • University of British Columbia, Vancouver, British Columbia, Canada
    • ,
  • Karen Kuntz, ScD

      Affiliations

    • Harvard School of Public Health, Boston, MA
    • ,
  • PAD Investigators

Received 9 May 2007; received in revised form 29 August 2007, 30 April 2008, 21 October 2008 and 5 December 2008; accepted 21 January 2009. published online 26 March 2009.

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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 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Theodore R. Delbridge, MD, MPH

 Author contributions: GN, EH, and KK conceived the study, designed the trial, and obtained research funding. GN, EH, and AB supervised the conduct of the trial and data collection. AB undertook recruitment of participating centers and patients and managed the data, including quality control. EH, AB, and KK provided statistical advice on study design and analyzed the data. GN drafted the article, and all authors contributed substantially to its revision. GN takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. For full disclosures, see Appendix E2, available at http://www.annemergmed.com.

 Publication date: Available online March 25, 2009.

PII: S0196-0644(09)00101-2

doi:10.1016/j.annemergmed.2009.01.021

Refers to article:

  • Lay Responder Defibrillation, Pancake Breakfasts, and Survival From Out-of-Hospital Cardiac Arrest , 13 April 2009

    Daniel W. Spaite
    Annals of Emergency Medicine August 2009 (Vol. 54, Issue 2, Pages 236-238)

Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 226-235.e2, August 2009

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