Cram Peter, Vijan Sandeep, Fendrick A Mark
Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 6SE GH, Iowa City, IA 52242, USA.
J Gen Intern Med. 2003 Sep;18(9):745-54. doi: 10.1046/j.1525-1497.2003.21139.x.
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.
Markov Decision Model employing a societal perspective.
Selected public locations in the United States.
A simulated cohort of the American public.
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.
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.
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.
美国心脏协会（AHA）建议，如果某一特定地点每年使用自动体外除颤器（AED）的概率至少为20%，则应考虑在该地点配备AED。我们试图评估AHA这一建议以及在已知心脏骤停发生率的特定公共场所部署AED的成本效益。
采用社会视角的马尔可夫决策模型。
美国选定的公共场所。
模拟的美国公众队列。
策略1：心脏骤停患者由配备AED的紧急医疗服务机构（EMS-D）进行治疗。策略2：患者接受作为公众可获取除颤计划一部分而部署的AED治疗。两种策略的区别仅在于AED的初始可及性及其对心脏骤停存活率的影响。
在部署的AED每5年用于1例心脏骤停患者（每年AED使用概率为20%）的基本假设下，与EMS-D治疗相比，部署AED每获得一个质量调整生命年（QALY）的成本为30,000美元。如果AED每年使用概率为12%或更高，则每获得一个QALY，AED部署成本低于50,000美元。在将AED每年使用概率保持在20%的情况下进行的蒙特卡罗模拟表明，87%的试验成本效益比低于每QALY 50,000美元。
在一系列公共场所部署AED可能具有成本效益。当前AHA指南限制过严。基于临床和经济理由，可合理有限度地扩大这些计划。
