Berger S, Whitstone B N, Frisbee S J, Miner J T, Dhala A, Pirrallo R G, Utech L M, Sachdeva R C
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Pediatr Cardiol. 2004 Nov-Dec;25(6):660-7. doi: 10.1007/s00246-003-0668-z.
Public access defibrillation (PAD) in the adult population is thought to be both efficacious and cost-effective. Similar programs aimed at children and adolescents have not been evaluated for their cost-effectiveness. This study evaluates the potential cost-effectiveness of implementing Project ADAM, a program targeting children and adolescents in high schools in the Milwaukee Public School System. Project ADAM provides education about cardiopulmonary resuscitation (CPR) and the warning signs of sudden cardiac death (SCD) and training in the use and placement of automated external defibrillators (AEDs) in high schools. We developed decision analysis models to evaluate the cost-effectiveness of the decision to implement Project ADAM in public high schools in Milwaukee. We examined clinical model and public policy applications. Data on costs included estimates of hospital-based charges derived from a pediatric medical center where a series of patients were treated for SCD, educational programming, and the direct costs of one AED and training for 15 personnel per school. We performed sensitivity analyses to assess the variation in outputs with respect to changes to input data. The main outcome measures were Life years saved and incremental cost-effectiveness ratios. At an arbitrary societal willingness to pay $100,000 per life year saved, the policy to implement Project ADAM in schools is a cost-effective strategy at a threshold of approximately 5 patients over 5 years for the clinical model and approximately 8 patients over 5 years for the public policy model. Implementation of Project ADAM in high schools in the United States is potentially associated with an incremental cost-effectiveness ratio that is favorable.
成人公共除颤（PAD）被认为既有效又具有成本效益。针对儿童和青少年的类似项目尚未对其成本效益进行评估。本研究评估了实施“亚当计划”的潜在成本效益，该计划针对密尔沃基公立学校系统中的高中生。“亚当计划”在高中提供心肺复苏（CPR）教育、心脏性猝死（SCD）警示信号教育以及自动体外除颤器（AED）使用和放置培训。我们开发了决策分析模型，以评估在密尔沃基公立高中实施“亚当计划”这一决策的成本效益。我们研究了临床模型和公共政策应用。成本数据包括来自一家儿科医疗中心的医院收费估计值，该中心治疗了一系列心脏性猝死患者、教育项目费用，以及每所学校一台AED的直接成本和15名人员的培训成本。我们进行了敏感性分析，以评估输出结果随输入数据变化的差异。主要结果指标是挽救的生命年数和增量成本效益比。在社会愿意为每挽救一个生命年支付100,000美元的任意阈值下，在学校实施“亚当计划”的政策对于临床模型而言，在5年内约5名患者的阈值下是具有成本效益的策略；对于公共政策模型而言，在5年内约8名患者的阈值下是具有成本效益的策略。在美国高中实施“亚当计划”可能具有有利的增量成本效益比。
