IntraVenous vs IntraOsseous access in Cardiac Arrest: the omitted economic question (IVOCA study)

Area of Science:

• Emergency Medicine
• Health Economics
• Clinical Practice

Background:

• Intraosseous (IO) access is increasingly utilized in out-of-hospital cardiac arrest (OHCA) care.
• Despite higher device costs, IO access has not demonstrated clinical superiority over peripheral intravenous (IV) access.

Purpose of the Study:

• To conduct a cost-minimization analysis comparing device-related costs of current IV/IO practices with hypothetical alternative strategies.
• To evaluate the economic implications of different vascular access approaches in OHCA resuscitation.

Main Methods:

• Retrospective cohort study using French national OHCA registry data (2013-2024).
• Cost analysis comparing IV catheters (€0.6) and IO needles (€109).
• Scenario modeling to estimate device costs for first-line IO versus stepwise IV-to-IO strategies.

Main Results:

• IO device costs significantly increased annually, totaling €133,198 versus €2555 for IV over the study period.
• Scenario modeling showed systematic first-line IO access costing €349 per ROSC and €3974 per survivor.
• A strategy without IO access was estimated at €2 per ROSC and €22 per survivor.

Conclusions:

• Increased IO use in OHCA correlates with substantially higher device expenditures.
• An IV-first strategy with selective IO use is economically preferable due to the lack of proven clinical superiority of IO access.
• Healthcare providers should consider cost-effectiveness when choosing vascular access methods in OHCA resuscitation.