Table 2 Extracted items from included studies
Study | Study Characteristics | Results | |
|---|---|---|---|
Descriptive characteristics | Technical characteristics | ||
Achana (2020) [22] | Perspective: Health system Intervention/Comparator: Parenteral adrenaline/saline placebo Simulated population: 8,014 adult patients with out-of-hospital cardiac arrest in the UK Country/Currency (adj. year): UK;GBP (2017) | Modeling approach: Markov model Time horizon: 6 months and lifetime Discounting: 3.5% Threshold used: £20,000 to £30,000/QALY | Results: £81,070/QALY Author's conclusions: Adrenaline was not cost-effective when only directly related costs and consequences are considered However, incorporating the indirect economic effects associated with transplanted organs substantially alters cost-effectiveness, suggesting decision-makers should consider the complexity of direct and indirect economic impacts of adrenaline % EE assessment satisfied: 92% |
Aguilera Campos (2012) [23] | Perspective: Not reported Intervention/Comparator: Increasing number of ambulances vs. keeping same number of ambulances and equipping police with AED and CPR training Simulated population: 11,000 patients with OHCA Country/Currency (adj. year): Mexico;MXN (NR) | Modeling approach: Decision-analytic model Time horizon: not reported Discounting: n/a Threshold used: Not reported | Results: 5.8–60 million MEX$ /LS ambulance; 0.5–5.5 million MEX$ / life saved (police first) Author's conclusions: In Queretaro interventions can be performed taking advantage of the response capacity of the existing police focused on diminishing mortality from OCHA at a lesser cost than delegating this function only to ambulances % EE assessment satisfied: 40% |
Al-Badriyeh (2022) [24] | Perspective: Payer Intervention/Comparator: Out-of-hospital extracorporeal cardiopulmonary resuscitation (OH-ECPR) vs in-hospital extracorporeal cardiopulmonary resuscitation (IH-ECPR) Simulated population: 1000 hypothetical OHCA patients with refractory VF or pulseless VT Country/Currency (adj. year): Qatar;QAR (2022) | Modeling approach: Decision-analytic model Time horizon: 1 year Discounting: No discount Threshold used: QAR 546,000/ case of success | Results: $127,634/ case of success Author's conclusions: OHECPR for OHCA patients, who are refractory to conventional CPR, is most likely a cost-effective approach relative to the IH-ECPR, supporting the increased utilization of the former as a potentially advantageous resuscitative approach in the OHCA patients % EE assessment satisfied: 88% |
Andersen (2019) [25] | Perspective: Health system and societal Intervention/Comparator: public AED/none Simulated population: Public out-of-hospital cardiac arrest in the United States without emergency medicine service personnel present at the time of cardiac arrest Country/Currency (adj. year): USA;USD (2017) | Modeling approach: Decision-analytic Markov model Time horizon: Lifetime Discounting: 3% Threshold used: $150,000/QALY | Results: $13,700/QALY (health system perspective) or $53,797/QALY (societal perspective) Author's conclusions: Public AEDs are a cost-effective public health intervention in the United States % EE assessment satisfied: 92% |
Bauer (2021) [26] | Perspective: Not reported Intervention/Comparator: Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS Simulated population: Population living in urban clusters and in urban centres13 and (2) not covered by EMS within 10 min time-to-defibrillation Country/Currency (adj. year): Germany;EUR (NR) | Modeling approach: Microsimulation model Time horizon: Not reported Discounting: n/a Threshold used: £20,000 to £30,000/QALY | Results: €23,568/LYS Author's conclusions: Demonstrated the relevant life-saving potential of UAV equipped with AED in out-of- hospital cardiovascular arrests: 1477 to 1845 additional years of life can be gained on an annual average compared with EMS % EE assessment satisfied: 36% |
Benger (2022) [27] | Perspective: Health system Intervention/Comparator: i-gel vs tracheal intubation Simulated population: Patients aged ≥ 18 years who had a non-traumatic out-of-hospital cardiac arrest and were attended by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017 Country/Currency (adj. year): England;GBP (2018) | Modeling approach: within trial economic analysis Time horizon: 6 month Discounting: No discount Threshold used: NR | Results: Dominated Author's conclusions: i-gel has a low probability of being cost-effective, regardless of the willingness-to-pay threshold. Overall, there is no evidence of a difference in cost-effectiveness between the groups % EE assessment satisfied: 72% |
Benson (2022) [28] | Perspective: Societal Intervention/Comparator: School-based AEDs vs no AED usage Simulated population: School-based OHCAs in region served by West Midlands Ambulance Service Country/Currency (adj. year): England;GBP (2019) | Modeling approach: Decision-analytic model Time horizon: Lifetime Discounting: No reported Threshold used: £20,000/QALY | Results: £8,916/QALY Author's conclusions: A strategy of placing AEDs in schools is likely to be cost-effective % EE assessment satisfied: 76% |
Bogle (2019) [29] | Perspective: Payer Intervention/Comparator: AED drone network vs no drone network for AED Simulated population: 16,503 OHCAs Country/Currency (adj. year): USA;USD (NR) | Modeling approach: Integer linear programming decision model Time horizon: 4 yrs Discounting: 3% Threshold used: $50,000/QALY | Results: $858/QALY Author's conclusions: With proper integration into existing systems, large-scale networks for drone AED delivery have the potential to substantially improve OHCA survival rates while remaining cost-effective % EE assessment satisfied: 68% |
Bouland (2015) [30] | Perspective: Health system Intervention/Comparator: Bystander CPR vs no bystander CPR Simulated population: 371 nontraumatic OHCAs Country/Currency (adj. year): USA;USD (2013) | Modeling approach: Decision-analytic model Time horizon: 10 yrs Discounting: n/a Threshold used: $100,000/QALY | Results: $22,539/QALY Author's conclusions: The cost-effectiveness findings of this analysis demonstrate the financial utility of bystander CPR training % EE assessment satisfied: 88% |
Cappato (2006) [31] | Perspective: Health system Intervention/Comparator: with and without AED program (AED added to ambulance system) Simulated population: Consecutive patients who, outside of the county hospitals, had been unconscious and unresponsive either suddenly or after a brief prodrome, had no palpable pulse, and had no spontaneous respiration Country/Currency (adj. year): Italy;EUR (NR) | Modeling approach: Within trial economic analysis Time horizon: Not reported Discounting: n/a Threshold used: Not reported | Results: $23,661/QALY Author's conclusions: UAV equipped with AED can be considered cost-effective and life-saving and can gain 1477 to 1845 additional years of life on an annual average compared with EMS % EE assessment satisfied: 36% |
Cram (2003) [32] | Perspective: Societal Intervention/Comparator: Strategy 1: individuals experiencing cardiac arrest were treated by EMS equipped with AEDs, Strategy 2: individuals treated with AEDs deployed as part of a public access defibriliation program. – Public access AEDs Simulated population: Simulated cohort of the American public Country/Currency (adj. year): USA;USD (2002) | Modeling approach: Decision-analytic model Time horizon: Not reported Discounting: 3% Threshold used: $50,000/QALY | Results: $30,000/QALY Author's conclusions: Findings support a policy of AED deployment at selected public locations–and also suggests that deployment of AEDs in hotels and retail stores may not be justified on clinical and economic grounds alone % EE assessment satisfied: 84% |
Cram (2005) [33] | Perspective: Societal Intervention/Comparator: in-home cardiac arrest treated with emergency medical services equipped with AEDs vs received initial treatment with an in-home AED, followed by EMS – In home AEDs to adults > 60 Simulated population: American adults 60 years of age at progressively greater risk for SCD Country/Currency (adj. year): USA;USD (2004) | Modeling approach: Markov model Time horizon: Lifetime Discounting: 3% Threshold used: $50,000 to $100,000/QALY | Results: $216,000/QALY Author's conclusions: The cost-effectiveness of in-home AEDs is intimately linked to individuals’ risk of SCD % EE assessment satisfied: 80% |
Doan (2022) [34] | Perspective: Health system Intervention/Comparator: Extracorporeal cardiopulmonary resuscitation (E-CPR) v conventional CPR (C-CPR) Simulated population: Country/Currency (adj. year): Australia;AUD (2021) | Modeling approach: Decision-analytic Markov model Time horizon: Lifetime Discounting: 3% Threshold used: 82,599 AUD/QALY | Results: 45,716 AUD/QALY Author's conclusions: E-CPR has median ICER that is below common accepted WTP thresholds % EE assessment satisfied: 88% |
Folke (2009) [35] | Perspective: Payer Intervention/Comparator: AED vs non AED– Public Access AEDs Simulated population: All patients with sudden cardiac arrest confirmed by the absence of consciousness, pulse, and breathing from 1994 to 205 – 5420 total Country/Currency (adj. year): Denmark;USD (2008) | Modeling approach: Not reported Time horizon: 10 yrs Discounting: n/a Threshold used: Not reported | Results: $33,100/QALY (ERC) or $40,900/QALY (AHA) Author's conclusions: A high proportion of cardiac arrests in public can be covered by strategic placement of AEDs within a limited area of a city center and with acceptable costs % EE assessment satisfied: 60% |
Forrer (2002) [36] | Perspective: Community Intervention/Comparator: (1) police first response and ALS care (No-AED) and; (2) AED equipped police first response (P-AED) with subsequent ALS care Simulated population: All adult patients who experienced a cardiac arrest of presumed cardiac origin and were transported to, or received medical direction from William Beaumont Hospital Country/Currency (adj. year): USA;USD (1999) | Modeling approach: Before and after quasi-experimental study Time horizon: 7 yrs Discounting: n/a Threshold used: $19,000/ life saved | Results: $50,641/LS or $11,562/LYS Author's conclusions: This study concluded that police could effectively lower the call-to-shock time significantly, and increase ROSC significantly over controls % EE assessment satisfied: 72% |
Foutz (2000) [37] | Perspective: Health system Intervention/Comparator: Placing AEDs in LTCF vs current standard (no AEDs) Simulated population: 160 patients in cardiac arrest in long term care facilities Country/Currency (adj. year): USA;USD (NR) | Modeling approach: Not reported Time horizon: 4 yrs Discounting: 5% Threshold used: $100,000/QALY | Results: $87,837/ LS Author's conclusions: Placing AEDs in LTCFs has a reasonable cost–utility if a hospital discharge survival rate of 25% of patients found in VF can be achieved % EE assessment satisfied: 56% |
Ginsberg (2015) [38] | Perspective: Societal Intervention/Comparator: The “treatment bundle” provided to patients suffering cardiac arrest including basic and advanced life support by the MDA, transfer to an Emergency Medicine Department (ED), treatment in the ED and throughout the hospital admission and appropriate post hospital discharge care (including cardiac rehabilitation, home care, nursing care and mechanical ventilation) Simulated population: Patients aged over 18 years with non-traumatic cardiac arrest in the Jerusalem district with EMS documented pulselessness accompanied by a non-perfusing rhythm Country/Currency (adj. year): Israel;USD (2011) | Modeling approach: Decision-analytic model Time horizon: NR Discounting: 3% Threshold used: $87,450/ DALY | Results: $28,864/ DALY Author's conclusions: The current package of OHCA interventions in Jerusalem appears to be very cost-effective as the cost per averted DALY of $28,864 is less than the Gross Domestic Product per capita ($33,261) % EE assessment satisfied: 60% |
Groeneveld (2001) [39] | Perspective: Societal Intervention/Comparator: AED placement Simulated population: 627,956 American Airlines flights in 1997–1999 Country/Currency (adj. year): USA;USD (1997–1999) | Modeling approach: Decision-analytic model Time horizon: Lifetime Discounting: 3% Threshold used: $50,000/QALY | Results: $35,300 on aircraft > 200 seats; $640,800 on aircraft > 100 seats; $94,700/QALY on all aircraft Author's conclusions: The cost-effectiveness of placing AEDs on commercial aircrafts compares favorable with the cost-effectiveness of widely accepted medical interventions and health policy regulations, but is critically dependent on the passenger capacity of the aircraft % EE assessment satisfied: 88% |
Groeneveld (2005) [40] | Perspective: Societal Intervention/Comparator: three strategies for training a cohort of laypersons in resus citation and defibrillation. (1) training unselected laypersons with a standard CPR/defibrillation course (2) CPR/ defibrillation training with purchase of an automated external defibrillator. The final strategy was no CPR/defibrillation training for unselected laypersons Simulated population: not applicable Country/Currency (adj. year): USA;USD (2004) | Modeling approach: Decision-analytic model Time horizon: Lifetime Discounting: 3% Threshold used: Not reported | Results: $202,400/QALY general population; $58,800/QALY if trainee lives w/ person > 75 Author's conclusions: Purchase of a home defibrillator was cost-effective at a threshold of $100,000 per QALY if the device cost less than $5, or if the household risk of cardiac arrest exceeded 32 times the national aver- age. None of the sensitivity analyses for unselected training yielded a cost per QALY value $50,000 % EE assessment satisfied: 76% |
Haag (2020) [41] | Perspective: Societal Intervention/Comparator: In-home AED Simulated population: A theoretical cohort of 15,50 ten-year-old children with hypertrophic cardiomyopathy Country/Currency (adj. year): USA;USD (2019) | Modeling approach: Markov model Time horizon: Not reported Discounting: 3% Threshold used: $100,000/QALY | Results: $86,458/QALY Author's conclusions: For children at intermediate risk for SCD and HCM, in home AED is cost-effective, resulting in fewer deaths and increased QALYS for a cost below the willingness-to-pay threshold % EE assessment satisfied: 76% |
Jakobsson et al. [42] | Perspective: Not reported Intervention/Comparator: Specially trained EMTs Simulated population: 28 patients successfully resuscitated Country/Currency (adj. year): Sweden;USD (1987) | Modeling approach: Decision-analytic model Time horizon: 1 yr Discounting: n/a Threshold used: Not reported | Results: $14,700/LS Author's conclusions: Training of EMTs is an inexpensive way of providing early defibrillation to out-of-hospital CA patients % EE assessment satisfied: 44% |
Jermyn BD. (2000) [43] | Perspective: Not reported Intervention/Comparator: recently initiated first-responder program in an urban center in southwestern Ontario Simulated population: 88000 Country/Currency (adj. year): Canada;USD (2000) | Modeling approach: Not reported Time horizon: Not reported Discounting: 5% Threshold used: Not reported | Results: $6,776/LS (urban; control), $49,274/LS (rural; experimental) Author's conclusions: The cost per life saved for a rural first-responder defibrillation program is significantly more expensive than one for an urban center. However, the cost per life saved is still economical compared with common treatments for other life-threatening illnesses % EE assessment satisfied: 52% |
Marti (2017) [44] | Perspective: Health system Intervention/Comparator: LUCAS-2, a mechanical device for CPR as compared to manual chest compressions in adults – (Mechanical CPR) Simulated population: 4,471 adults with non-traumatic, out-of-hospital cardiac arrest from four UK Ambulance Services Country/Currency (adj. year): UK;GBP (Not reported) | Modeling approach: Decision-analytic model Time horizon: Not reported Discounting: n/a Threshold used: £20,000/ QALY | Results: Manual CPR dominates mechanical CPR Author's conclusions: LUCAS-2 is dominated by manual chest compression % EE assessment satisfied: 68% |
Mears (2006) [45] | Perspective: Not reported Intervention/Comparator: AED placement in rural areas Simulated population: not applicable Country/Currency (adj. year): USA;USD (NR) | Modeling approach: Not reported Time horizon: Not reported Discounting: n/a Threshold used: Not reported | Results: $11,457/LS or $2,616/LYS Author's conclusions: This model provides guidance to federal, state, and local EMS administrators who are attempting to identify where to place a limited number of AEDs across a very large geographic area with varying population densities and cardiac arrest rates % EE assessment satisfied: 24% |
Moran (2015) [46] | Perspective: Societal Intervention/Comparator: AED placement Simulated population: All EMS attended OHCAs where resuscitation was attempted Country/Currency (adj. year): Ireland;EUR (NR) | Modeling approach: Decision-analytic markov model Time horizon: Not reported Discounting: n/a Threshold used: €45,000/QALY | Results: €95,640/QALY Author's conclusions: A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective % EE assessment satisfied: 72% |
Nichol (1996) [47] | Perspective: Societal Intervention/Comparator: (1) improvement in response time by addition of unit hours in a one-tier EMS system by the addition of more EMS providers in ambulances, (2) improvement in response time within a two-tier EMS system by the addition of more BLS/BLS-D providers in pump vehicles to the first tier, (3) improvement in response time within a two-tier EMS system by the addition of more BLS/BLS-D providers in ambulances to the first tier, (4) change from a one-tier EMS system to a two-tier EMS system by addition of BLS/BLS-D providers in pump vehicles as the first tier, (5) change from a one-tier EMS system to a two-tier EMS system by the addition of BLS/BLS-D providers in ambulances as the first tier Simulated population: Cardiac arrest patients Country/Currency (adj. year): Canada;USD (1993) | Modeling approach: Decision-analytic model Time horizon: Not reported Discounting: 5% Threshold used: $60,000/ QALY | Results: $53,000/QALY Author's conclusions: The most attractive options in terms of incremental cost-effectiveness were improved response time in a two-tier EMS system or change from a one-tier to a two-tier EMS system % EE assessment satisfied: 68% |
Nichol (1998) [48] | Perspective: Health system Intervention/Comparator: Standard EMS systems vs EMS supplemented by public access defibrillation (PAD) Simulated population: not explicitly mentioned Country/Currency (adj. year): USA;USD (1996) | Modeling approach: Decision-analytic model Time horizon: Not reported Discounting: 3% Threshold used: $50,000/QALY | Results: $44,000/QALY Author's conclusions: Although more expensive than standard EMS for sudden cardiac arrest, PAD may be economically attractive % EE assessment satisfied: 72% |
Nichol (2003) [49] | Perspective: Societal Intervention/Comparator: Standard EMS versus targeted non-traditional responders Simulated population: 148 patients Country/Currency (adj. year): USA;USD (2003) | Modeling approach: Markov model Time horizon: Lifetime Discounting: 3% Threshold used: $100,000/QALY | Results: $56,700/QALY Author's conclusions: Where cardiac arrest is frequent and response time intervals are short, rapid defibrillation by targeted non-traditional responders may be a good value for the money compared with standard EMS % EE assessment satisfied: 72% |
Nichol (2009) [50] | Perspective: Societal Intervention/Comparator: Public access defibrillation (CPR only vs CPR + AED (bystanders) Simulated population: Not applicable Country/Currency (adj. year): USA and Canada;USD (1996) | Modeling approach: Decision-analytic model Time horizon: Lifetime Discounting: 3% Threshold used: $100,000/QALY | Results: $44,000/QALY (PAD lay responder), $27,200/QALY (PAD police) Author's conclusions: 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 % EE assessment satisfied: 52% |
Ornato (1988) [51] | Perspective: Not reported Intervention/Comparator: Basic EMT, EMTs trained in defibrillation, and paramedics Simulated population: Not applicable Country/Currency (adj. year): USA;USD (NR) | Modeling approach: Not reported Time horizon: Not reported Discounting: n/a Threshold used: Not reported | Results: $7,687/LS basic EMT; $2,126/LS EMT trained defibrillation; $2,289/LS paramedics Author's conclusions: From a medical and a cost-effective standpoint, all communities served by basic EMTs should consider upgrading them to at least the defibrillation trained EMT level % EE assessment satisfied: 32% |
Osorio Cuevas (2019) [52] | Perspective: Health system Intervention/Comparator: CPR with AED vs basic CPR without the use of the defibrillator Simulated population: People with loss of consciousness in crowded spaces with large audiences Country/Currency (adj. year): Colombia;COP (2016) | Modeling approach: Decision-analytic model Time horizon: Unconsciousness to hospital admission Discounting: 5% Threshold used: 10 million COP/ life saved | Results: 3,267,777 COP/ LS Author's conclusions: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System % EE assessment satisfied: 80% |
Perkins (2021) [53] | Perspective: Health system Intervention/Comparator: Adrenaline Simulated population: 8014 Adults treated for an out-of-hospital cardiac arrest Country/Currency (adj. year): UK;GBP (2016–2017) | Modeling approach: Decision-analytic model Time horizon: Lifetime Discounting: 3.5% Threshold used: £20,000 to £30,000/QALY | Results: £1,693,003 / QALY first 6 months or £81,070/QALY over lifetime Author's conclusions: Adrenaline improved long-term survival, but there was no evidence that it significantly improved neurological outcomes. The incremental cost-effectiveness ratio per quality-adjusted life-year exceeds the threshold of £20,000–30,000 per quality-adjusted life-year usually supported by the NHS % EE assessment satisfied: 84% |
Rauner et al. (2003) [54] | Perspective: Societal Intervention/Comparator: AED programmes for the Austrian Red Cross/no AED program Simulated population: N/A Country/Currency (adj. year): Austria;Euro (2003) | Modeling approach: Decision-analytic model Time horizon: Not reported Discounting: 3% Threshold used: $50,000/QALY | Results: €17,139/QALY Author's conclusions: The decision of the Red Cross to equip all ambulances with AEDs was cost-effective % EE assessment satisfied: 68% |
Shaker (2022) [55] | Perspective: Societal and Health system Intervention/Comparator: Portable SMall AED for Rapid Treatment of SCA (SMART) Simulated population: 600,000 sudden cardiac arrest risk patients who had not received implantable cardioverter defibrillator Country/Currency (adj. year): USA;USD (2021) | Modeling approach: Markov model Time horizon: 50-year Discounting: 3% Threshold used: $100,000/ QALY | Results: Societal: $53,925/QALY; Healthcare: $59,672/QALY Author's conclusions: A SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk % EE assessment satisfied: 80% |
Sharieff (2007) [56] | Perspective: Payer Intervention/Comparator: On-site AED management compared with patients managed on-site without AEDs (Public access AEDs) Simulated population: Fictitious male and female new cardiac arrest patients in Ontario, Canada (mean age, 69 +—13 years) Country/Currency (adj. year): Canada;CAD (2005) | Modeling approach: Decision-analytic model Time horizon: 5 yrs Discounting: 3% Threshold used: Not reported | Results: $511,766 Office; $2,360,023 Apartment; $87,569 high risk homes; $1,529,371 homes of high risk > 55 Author's conclusions: Indiscriminate deployment of AEDs is not a cost-effective means of improving health outcomes of cardiac arrest. Their use should be restricted to emergency response programs, high-risk sites (such as hospitals), and high-risk patients % EE assessment satisfied: 84% |
Shibahashi (2022) [57] | Perspective: Payer Intervention/Comparator: BLS termination-of-resuscitation, ALS TOR or no TOR Simulated population: All-Japan Utstein registry of 126,271 patients median age 80 yrs Country/Currency (adj. year): Japan;JPY (2013) | Modeling approach: Decision-analytic Markov model Time horizon: Lifetime Discounting: 2% Threshold used: $45,455/ QALY | Results: $23,851/QALY Author's conclusions: No-rule scenario was not cost-effective compared with BLS-rule scenario within acceptable willingness-to-pay thresholds % EE assessment satisfied: 88% |
Stokes (2021) [58] | Perspective: Health system Intervention/Comparator: i-gel supraglotticairway (SGA) vs tracheal intubation (TI) Simulated population: 9296 non traumatic OHCA patients Country/Currency (adj. year): UK;GBP (2016/17) | Modeling approach: Within trial economic analysis Time horizon: 6 months Discounting: No discount Threshold used: £20,000/ QALY | Results: No evidence of difference in cost-effectiveness Author's conclusions: TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results % EE assessment satisfied: 80% |
Sund (2012) [59] | Perspective: Not reported Intervention/Comparator: Fire stations in the County of Stockholm equipped with AEDs and dispatched in parallel with ambulances to all suspected cases of OHCA vs no dispatch of fire stations Simulated population: 836 patients with OHCA Country/Currency (adj. year): Sweden;EUR (2007) | Modeling approach: Decision-analytic model Time horizon: 10 yrs Discounting: 4% Threshold used: €65,000/ life saved | Results: €13,000/QALY; €60,000/LS Author's conclusions: The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. The return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in % EE assessment satisfied: 72% |
Urban et al. [60] | Perspective: Not reported Intervention/Comparator: Paramedic program Simulated population: 1,035 patients Country/Currency (adj. year): USA;USD (1978) | Modeling approach: Not reported Time horizon: 3 yrs Discounting: n/a Threshold used: $21,000/ LYS | Results: $42,358/LS Author's conclusions: Even at the upper bound of cost per life saved, this program is cost-beneficial; it compares favorably with Acton's estimate of the value of saving a myocardial infarction patient (approximately $48,000 in 1978 dollars) % EE assessment satisfied: 52% |
Valenzuela (1990) [61] | Perspective: Not reported Intervention/Comparator: EMS system capable of successfully resuscitating patients from OHCA vs. EMS system without this capability Simulated population: 190 patients experiencing nontraumatic, prehospital cardiopulmonary arrest in Tucson, Arizona, between October 1988 and July 1989 Country/Currency (adj. year): USA;USD (1989) | Modeling approach: Not reported Time horizon: Not reported Discounting: 5% Threshold used: Not reported | Results: $118,939/ LS or $8,886/ LYS Author's conclusions: Out-of-hospital treatment by paramedics of cardiopulmonary arrest is more cost effective than heart, liver, bone marrow transplantation, or curative chemotherapy for acute leukemia % EE assessment satisfied: 60% |
van Alem (2004) [62] | Perspective: Patient Intervention/Comparator: Reduction in time to shock of 2, 4, and 6 min Simulated population: 308 patients OHCA patients witnessed with shockable rhythm Country/Currency (adj. year): Netherlands;EUR (2001) | Modeling approach: Not reported Time horizon: 6 months Discounting: n/a Threshold used: €20,000/life saved | Results: €17,508/LS 2 min reduction; €14,303/LS 4 min reduction; €12,708/LS 6 min reduction Author's conclusions: Costs per survivor were lowest with the shortest time to shock because of shorter stay in the intensive care unit. Reducing the time to defibrillation increases the healthcare costs by an acceptable amount according to current standards and is economically attractive % EE assessment satisfied: 64% |
Vercammen (2020) [63] | Perspective: Health system Intervention/Comparator: current OHCA care vs nation-wide Emergency Volunteer Application, a Belgian smartphone application that mobilizes volunteers to perform CPR and defibrillation with publicly available AED after an emergency call for suspected OHCA. implementation Simulated population: Patients suffering from witnessed OHCA of cardiac origin in the Belgian population (n = 6150 cases) Country/Currency (adj. year): Belgium;EUR (NR) | Modeling approach: Accessible model Time horizon: 6 yrs Discounting: n/a Threshold used: Not reported | Results: €17,000/QALY Author's conclusions: Nation-wide implementation of EVapp, a novel smartphone application to mobilize trained volunteers to nearby OHCA victims, would increase survival without major increase in costs. According to the best case estimates, the increase in survival for witnessed OHCA of cardiac origin was projected at 15% over the baseline scenario. This considerable increase in survival was not associated with a major increase in cost per QALY % EE assessment satisfied: 56% |
von Vopelius-Feldt (2019) [64] | Perspective: Health system Intervention/Comparator: ALS vs prehospital critical care + ALS Simulated population: Adult non-traumatic OHCA Country/Currency (adj. year): England;GBP (2016/2017) | Modeling approach: Markov model Time horizon: Lifetime Discounting: 3.5% Threshold used: £20,000/ QALY | Results: £11,407/QALY Author's conclusions: 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 % EE assessment satisfied: 80% |
Walker (2003) [69] | Perspective: Health system Intervention/Comparator: Defibrillators in major airports, railway and bus stations/no public place defibrillators Simulated population: all prehospital cardiac arrests due to presumed heart disease that occurred in a major airport, railway, or bus station Country/Currency (adj. year): Scotland;GBP (2000–2001) | Modeling approach: Not reported Time horizon: Lifetime Discounting: Outcomes 1.5%, Costs 6% Threshold used: £30,000/ QALY | Results: £41,146/QALY Author's conclusions: These costs represent poorer value for money than some alternative strategies, such as the use of other trained first responders, and exceed the commonly used cut-off levels for funding % EE assessment satisfied: 60% |
Wei (2020) [65] | Perspective: Health system Intervention/Comparator: Ambulance response time, bystander CPR and AED Simulated population: Not applicable Country/Currency (adj. year): Singapore;SGD (NR) | Modeling approach: Decision-analytic model Time horizon: 1 yr Discounting: 3% Threshold used: Not reported | Results: Additional ambulances $13,6210/LYS; increased CPR training $29,5121/LYS; additional public AEDs $8,554/LYS Author's conclusions: Investing in AEDs had the most gain in survival, compared with leasing additional ambulances or increasing the number of people trained in CPR % EE assessment satisfied: 48% |
Yen (2006) [66] | Perspective: Health system Intervention/Comparator: EMT vs emergency physicians Simulated population: patients experiencing OHCA of non-traumatic origin with ALS activation, transported by EMS to nine medical centers in Taipei city, between November 1999 and December 2000 Country/Currency (adj. year): Taiwan;USD (2000) | Modeling approach: Decision-analytic model Time horizon: n/a Discounting: No discount Threshold used: Not reported | Results: $21,136/ LYS Author's conclusions: The use of EMTs as ALS care providers for OHCA patients in the two-tiered EMS system resulted in a reasonable cost-effectiveness ratio. EMTs could be considered as the second tier of EMS systems in urban areas in Taiwan % EE assessment satisfied: 60% |