Nichol G, Valenzuela T, Roe D, Clark L, Huszti E, Wells G A
F699 Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada.
Circulation. 2003 Aug 12;108(6):697-703. doi: 10.1161/01.CIR.0000084545.65645.28. Epub 2003 Aug 4.
Out-of-hospital cardiac arrest is frequent and has poor outcomes. Defibrillation by trained targeted nontraditional responders improves survival versus historical controls, but it is unclear whether such defibrillation is a good value for the money. Therefore, this study estimated the incremental cost effectiveness of defibrillation by targeted nontraditional responders in public settings by using decision analysis.
A Markov model evaluated the potential cost effectiveness of standard emergency medical services (EMS) versus targeted nontraditional responders. Standard EMS included first-responder defibrillation followed by advanced life support. Targeted nontraditional responders included standard EMS supplemented by defibrillation by trained lay responders. The analysis adopted a US societal perspective. Input data were derived from published or publicly available data. Future costs and effects were discounted at 3%. Monte Carlo simulation and sensitivity analyses assessed the robustness of results. Standard EMS had a median of 0.47 (interquartile range [IQR]=0.32 to 0.69) quality-adjusted life years and a median of 14 100 dollars (IQR=8600 dollars to 21 900 dollars) costs per arrest. Targeted nontraditional responders in casinos had an incremental cost of a median 56 700 dollars (IQR=44 100 dollars to 77 200 dollars) per additional quality-adjusted life year. The results were sensitive to changes in time to defibrillation, incidence of arrest, and number of devices required to implement rapid defibrillation.
Where cardiac arrest is frequent and response time intervals are short, rapid defibrillation by targeted nontraditional responders may be a good value for the money compared with standard EMS. The incidence of arrest should be considered when choosing locations to implement public access defibrillation.
院外心脏骤停很常见且预后较差。与历史对照相比，由经过培训的目标非传统急救人员进行除颤可提高生存率，但尚不清楚这种除颤是否具有成本效益。因此，本研究通过决策分析评估了在公共场所由目标非传统急救人员进行除颤的增量成本效益。
一个马尔可夫模型评估了标准紧急医疗服务（EMS）与目标非传统急救人员的潜在成本效益。标准EMS包括急救人员除颤，随后是高级生命支持。目标非传统急救人员包括由经过培训的非专业急救人员进行除颤补充的标准EMS。分析采用美国社会视角。输入数据来自已发表或公开可用的数据。未来成本和效果按3%进行贴现。蒙特卡洛模拟和敏感性分析评估了结果的稳健性。标准EMS每例心脏骤停的质量调整生命年中位数为0.47（四分位间距[IQR]=0.32至0.69），成本中位数为14100美元（IQR=8600美元至21900美元）。赌场中的目标非传统急救人员每增加一个质量调整生命年的增量成本中位数为56700美元（IQR=44100美元至77200美元）。结果对除颤时间、心脏骤停发生率以及实施快速除颤所需设备数量的变化敏感。
在心脏骤停频繁且响应时间间隔短的地方，与标准EMS相比，由目标非传统急救人员进行快速除颤可能具有成本效益。在选择实施公众可及除颤的地点时应考虑心脏骤停的发生率。
