Increasing cost-effectiveness of AEDs using algorithms to optimise location.

Area of Science:

• Public Health
• Health Economics
• Emergency Medicine

Background:

• Volunteer responder systems (VRSs) aim to improve survival from out-of-hospital cardiac arrest (OHCA) by reducing time to defibrillation.
• Automated external defibrillators (AEDs) are crucial for OHCA survival but are often underutilized due to suboptimal placement.
• Strategic placement of AEDs is key to maximizing their effectiveness within a VRS framework.

Purpose of the Study:

• To conduct a cost-effectiveness analysis of increasing the number of strategically placed AEDs within a VRS.
• To determine the optimal number of additional AEDs to maximize quality-adjusted life years (QALYs) gained.

Main Methods:

• Simulated combined response scenarios involving volunteers, police, firefighters, and emergency medical services for OHCAs.
• Applied a case study to Amsterdam, Netherlands, comparing strategies with 0 to 1480 additional AEDs.
• Calculated incremental cost-effectiveness ratios (ICERs) from a societal perspective and used logistic regression to estimate survival and neurological outcomes based on AED connection data.

Main Results:

• Adding up to 1120 strategically positioned AEDs was found to be cost-effective, with an ICER of €75,669/QALY at a willingness-to-pay threshold of €80,000/QALY.
• This strategy resulted in a gain of 0.111 QALYs per OHCA at an increased cost of €3792.
• Diminishing health benefits per additional AED were observed as the total number of AEDs increased.

Conclusions:

• Identified cost-effective strategies for optimizing AED placement within VRS.
• The findings support a significant increase in AED deployment in Amsterdam to enhance OHCA response.
• Strategic AED placement is a viable approach to improve public health outcomes in cardiac emergencies.