Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

von Vopelius-Feldt, Johannes; Powell, Jane; Benger, Jonathan Richard

Abstract

Objectives: This research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for outof-hospital cardiac arrest (OHCA)? What is the cost effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective? Setting A single National Health Service ambulance service and a charity-funded prehospital critical care service in England.
Participants : The patient population is adult, nontraumatic OHCA.

Methods: We combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital
ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.

Results: Costs of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%.

Conclusion: This is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive.
Knowledge of the MEID for prehospital critical care can guide future research in this field.
Trial registration number ISRCTN18375201

Citation

von Vopelius-Feldt, J., Powell, J., & Benger, J. R. (2019). Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model. BMJ Open, 9(7), e028574. https://doi.org/10.1136/bmjopen-2018-028574

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2019
• Online Publication Date: Jul 24, 2019
• Publication Date: Jul 24, 2019
• Deposit Date: Aug 7, 2019
• Publicly Available Date: Aug 12, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 7
• Pages: e028574
• DOI: https://doi.org/10.1136/bmjopen-2018-028574
• Keywords: General Medicine
• Public URL: https://uwe-repository.worktribe.com/output/1952443
• Publisher URL: https://bmjopen.bmj.com/content/9/7/e028574