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Cost-effectiveness of automated external defibrillator deployment in selected public locations
Peter Cram1, Sandeep Vijan, A Mark Fendrick
1Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 6SE GH, Iowa City, IA 52242, USA. peter-cram@uiowa.edu
Objective:
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.
Design:
Markov Decision Model employing a societal perspective.
Setting:
Selected public locations in the United States.
Patients:
A simulated cohort of the American public.
Intervention:
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.
Results:
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.
Conclusions:
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.