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Cost-effectiveness of automated external defibrillator deployment in selected public locations

  • Health Policy
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Received from the Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa

    Peter Cram MD, MBA

  2. Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, USA

    Sandeep Vijan MD, MS & A. Mark Fendrick MD

  3. Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies, USA

    A. Mark Fendrick MD

  4. Ann Arbor Veterans Affairs Health Services Research and Development Field Program, USA

    Sandeep Vijan MD, MS

  5. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Mich

    A. Mark Fendrick MD

Authors
  1. Peter Cram MD, MBA
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  2. Sandeep Vijan MD, MS
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  3. A. Mark Fendrick MD
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Corresponding author

Correspondence to Peter Cram MD, MBA.

Additional information

There was no external source of funding for this study. Dr. Cram was supported by a fellowship grant from the Agency for Healthcare Research and Quality during a portion of this work, and Dr. Vijan is a Veterans Affairs Health Services Research and Development Career Development Awardee. No funding agency had any role in the design, conduct, or reporting of the study.

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Cram, P., Vijan, S. & Mark Fendrick, A. Cost-effectiveness of automated external defibrillator deployment in selected public locations. J GEN INTERN MED 18, 745–754 (2003). https://doi.org/10.1046/j.1525-1497.2003.21139.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.21139.x

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