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Cost-effectiveness of advanced life support or prehospital critical care for out-of-hospital cardiac arrest: A decision analysis model

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

Authors

Johannes von Vopelius-Feldt johannes.vonvopelius-feldt@uwe.ac.uk

Jane Powell Jane.Powell@uwe.ac.uk
Professor in Public Health Economics

Jonathan Benger jonathan.benger@uwe.ac.uk



Abstract

Background
Rates of survival following out-of-hospital cardiac arrest (OHCA) remain low in the UK. To improve prehospital care for OHCA, some areas in the UK dispatch prehospital critical care teams to OHCA, in addition to the current standard of Advanced Life Support (ALS). Little is known about the cost-effectiveness of either level of prehospital care for 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 analysis model of ALS and prehospital critical care for OHCA. We aimed to answer the following questions: What are the costs of prehospital ALS and prehospital critical care for 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?

Results
Costs of prehospital ALS and prehospital critical care were £347 and £1,711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and post-discharge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11,407 per quality-adjusted life year (QALY). 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%.

Conclusions
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 incur 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.

Journal Article Type Article
Journal to be confirmed
Peer Reviewed Not Peer Reviewed
APA6 Citation von Vopelius-Feldt, J., Powell, J., & Benger, J. (in press). Cost-effectiveness of advanced life support or prehospital critical care for out-of-hospital cardiac arrest: A decision analysis model