Cost-effectiveness of a national public access defibrillation programme

Area of Science:

• Public health
• Health economics
• Emergency medicine

Background:

• Proposed Irish legislation mandates automated external defibrillators (AEDs) in public spaces to improve survival from out-of-hospital cardiac arrest (OHCA).
• The effectiveness and cost-effectiveness of this comprehensive AED deployment strategy require evaluation against alternative, more targeted approaches.

Purpose of the Study:

• To estimate the clinical and cost-effectiveness of proposed Irish legislation for public access defibrillation (PAD).
• To compare the comprehensive PAD program with alternative configurations involving targeted AED placement.

Main Methods:

• A cost-utility analysis was conducted from a societal perspective.
• Data on OHCA incidence and outcomes were sourced from the Irish Out-of-Hospital Cardiac Arrest Register (OHCAR).
• Costs were gathered from the Irish health service, device suppliers, and training providers.

Main Results:

• The most comprehensive PAD scheme had an incremental cost-effectiveness ratio (ICER) of €928,450/QALY.
• A scaled-back program targeting specific high-incidence venues (transport stations, medical practices, entertainment, schools, fitness facilities) had an ICER of €95,640/QALY.
• Increasing AED utilization by 40% could make the scaled-back program cost-effective.

Conclusions:

• Nationwide PAD programs with widespread AED deployment are unlikely to be cost-effective.
• Future programs should prioritize locations with the highest OHCA incidence.
• Improving public awareness, CPR/AED training, and establishing an EMS-linked AED register are crucial for enhancing cost-effectiveness.