Department of Health Policy and Management, School of Medicine, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland; Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
Health Technology Assessment, Health Information and Quality Authority, George's Court, George's Lane, Dublin 7, Ireland.
Resuscitation. 2015 Jun;91:48-55. doi: 10.1016/j.resuscitation.2015.03.017. Epub 2015 Mar 28.
Proposed Irish legislation aimed at increasing survival from out-of-hospital-cardiac-arrest (OHCA) mandates the provision of automated external defibrillators (AEDs) in a comprehensive range of publicly accessible premises in urban and rural areas. This study estimated the clinical and cost effectiveness of the legislation, compared with alternative programme configurations involving more targeted AED placement.
We used a cost-utility analysis to estimate the costs and consequences of public access defibrillation (PAD) programmes from a societal perspective, based on AED deployment by building type. Comparator programmes ranged from those that only included building types with the highest incidence of OHCA, to the comprehensive programme outline in the proposed legislation. Data on OHCA incidence and outcomes were obtained from the Irish Out-of-Hospital-Cardiac-Arrest Register (OHCAR). Costs were obtained from the Irish health service, device suppliers and training providers.
The incremental cost effectiveness ratio (ICER) for the most comprehensive PAD scheme was €928,450/QALY. The ICER for the most scaled-back programme involving AED placement in transport stations, medical practices, entertainment venues, schools (excluding primary) and fitness facilities was €95,640/QALY. A 40% increase in AED utilisation when OHCAs occur in a public area could potentially render this programme cost effective.
National PAD programmes involving widespread deployment of static AEDs are unlikely to be cost-effective. To improve cost-effectiveness any prospective programmes should target locations with the highest incidence of OHCA and be supported by efforts to increase AED utilisation, such as improving public awareness, increasing CPR and AED training, and establishing an EMS-linked AED register.
旨在提高院外心脏骤停（OHCA）生存率的爱尔兰立法建议在城市和农村地区的广泛公共可及场所提供自动体外除颤器（AED）。本研究评估了该立法的临床和成本效益，与涉及更有针对性 AED 放置的替代方案配置进行了比较。
我们使用成本效益分析，根据建筑物类型的 AED 部署，从社会角度估算公众可获得的除颤（PAD）计划的成本和结果。比较方案范围从仅包括 OHCA 发生率最高的建筑物类型的方案，到拟议立法中的综合方案大纲。OHCA 发生率和结果数据来自爱尔兰院外心脏骤停登记处（OHCAR）。成本来自爱尔兰卫生服务、设备供应商和培训提供商。
最全面的 PAD 计划的增量成本效益比（ICER）为 928,450 欧元/QALY。涉及在交通站、医疗实践、娱乐场所、学校（不包括小学）和健身设施中放置 AED 的最具规模的方案的 ICER 为 95,640 欧元/QALY。当 OHCA 在公共场所发生时，AED 利用率增加 40%，则该方案可能具有成本效益。
涉及广泛部署静态 AED 的国家 PAD 计划不太可能具有成本效益。为了提高成本效益，任何未来的计划都应针对 OHCA 发生率最高的地点，并通过努力提高 AED 利用率来支持，例如提高公众意识、增加 CPR 和 AED 培训，以及建立与 EMS 相关联的 AED 登记处。
