Nichol G, Hallstrom A P, Ornato J P, Riegel B, Stiell I G, Valenzuela T, Wells G A, White R D, Weisfeldt M L
Loeb Medical Research Institute, University of Ottawa, Canada.
Circulation. 1998 Apr 7;97(13):1315-20. doi: 10.1161/01.cir.97.13.1315.
Approximately 360,000 Americans experience sudden cardiac arrest each year; current treatments are expensive and not very effective. Public access defibrillation (PAD) is a novel treatment for out-of-hospital sudden cardiac arrest that refers to use of automated external defibrillators by the lay public or by nonmedical personnel such as police. A clinical trial has been proposed to evaluate the effectiveness of public access defibrillation, but it is unclear whether such early defibrillation will offer sufficient value for money. Our objective was to estimate the potential cost-effectiveness of public access defibrillation by use of decision analysis.
A decision model compared the potential cost-effectiveness of standard emergency medical services (EMS) systems with that of EMS supplemented by PAD. We considered defibrillation by lay responders or police, using an analysis with a US health-care perspective. Input data were derived from published data or fiscal databases. Future costs and effects were discounted at 3%. Monte Carlo simulation was performed to estimate the variability in the costs and effects of each program. Sensitivity analyses assessed the robustness of the results to changes in input data. A standard EMS system had a median cost of $5900 per cardiac arrest patient (interquartile range, IQR, $3200 to $10,900) and yielded a median of 0.25 quality-adjusted life years (IQR, 0.20 to 0.30). PAD by lay responders had a median incremental cost of $44,000 per additional quality-adjusted life year (IQR, $29,000 to $68,900). PAD by police had a median incremental cost of $27,200 per additional quality-adjusted life year (IQR, $15,700 to $47,800). The results were sensitive to changes in the cost and relative survival benefit of PAD.
Although more expensive than standard EMS for sudden cardiac arrest, PAD may be economically attractive. The effectiveness and cost-effectiveness of PAD should be assessed in a randomized, controlled trial.
每年约有36万美国人经历心脏骤停；目前的治疗方法昂贵且效果不佳。公众可获取除颤（PAD）是一种针对院外心脏骤停的新型治疗方法，指的是由普通公众或警察等非医疗人员使用自动体外除颤器。已提议进行一项临床试验以评估公众可获取除颤的有效性，但尚不清楚这种早期除颤是否具有足够的性价比。我们的目标是通过决策分析来估计公众可获取除颤的潜在成本效益。
一个决策模型比较了标准紧急医疗服务（EMS）系统与补充了PAD的EMS系统的潜在成本效益。我们考虑了由非专业急救人员或警察进行除颤，采用美国医疗保健视角的分析方法。输入数据来自已发表的数据或财政数据库。未来成本和效果按3%进行贴现。进行蒙特卡洛模拟以估计每个项目成本和效果的变异性。敏感性分析评估了结果对输入数据变化的稳健性。一个标准的EMS系统每位心脏骤停患者的中位成本为5900美元（四分位间距，IQR，3200美元至10900美元），产生的中位质量调整生命年为0.25（IQR，0.20至0.30）。非专业急救人员进行PAD的每增加一个质量调整生命年的中位增量成本为44000美元（IQR，29000美元至68900美元）。警察进行PAD的每增加一个质量调整生命年的中位增量成本为27200美元（IQR，15700美元至47800美元）。结果对PAD的成本和相对生存获益的变化很敏感。
虽然对于心脏骤停而言，PAD比标准EMS更昂贵，但可能在经济上具有吸引力。应在一项随机对照试验中评估PAD的有效性和成本效益。
