英格兰院外心脏骤停的高级生命支持和院前危重病护理的成本效益：决策分析模型。
Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model.
机构信息
Faculty of Health and Applied Sciences, The University of the West of England, Bristol, UK
Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
出版信息
BMJ Open. 2019 Jul 24;9(7):e028574. doi: 10.1136/bmjopen-2018-028574.
OBJECTIVES
This research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective?
SETTING
A single National Health Service ambulance service and a charity-funded prehospital critical care service in England.
PARTICIPANTS
The patient population is adult, non-traumatic OHCA.
METHODS
We combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.
RESULTS
Costs of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%-5%.
CONCLUSION
This is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. 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. Knowledge of the MEID for prehospital critical care can guide future research in this field.
TRIAL REGISTRATION NUMBER
ISRCTN18375201.
目的
本研究旨在回答以下问题：院外心脏骤停（OHCA）的院前高级生命支持（ALS）和院前危重病护理的成本是多少？院前 ALS 的成本效益如何？为了具有成本效益，院前危重病护理需要使 OHCA 的生存率提高多少？
设置
在英格兰，一个单一的国民保健服务（NHS）救护车服务和一个慈善机构资助的院前危重病护理服务。
参与者
患者人群为成人、非创伤性 OHCA。
方法
我们将之前发表的研究数据与区域救护车服务和空中救护车慈善机构提供的数据相结合，创建了一个决策树模型，并结合了 OHCA 后成本和结果的马尔可夫模型。我们将 OHCA 的无治疗与当前院前 ALS 的标准护理进行了比较，并且将院前 ALS 与院前危重病护理进行了比较。为了反映基础数据的不确定性，我们使用了概率和双向敏感性分析。
结果
院前 ALS 和院前危重病护理的成本分别为每位患者 347 英镑和 1711 英镑。当 OHCA 院前、院内和出院后阶段的成本和结果相结合时，院前 ALS 的估计成本效益为每 11407 英镑/质量调整生命年。除了 ALS 之外，要使 OHCA 的院前危重病护理具有成本效益，还需要在院外存活率方面达到 3%-5%的最小经济重要差异（MEID）。
结论
这是第一个解决 OHCA 后院前危重病护理成本效益问题的经济分析。虽然每位 OHCA 患者的院前 ALS 和/或危重病护理的成本相对较低，但在存活患者的住院治疗和出院后，会产生大量成本。对院前危重病护理的 MEID 的了解可以指导该领域的未来研究。
试验注册号
ISRCTN85276528。
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