Health Care Costs and Financing

Greater deployment of automated external defibrillators at select public locations is likely to be cost effective

An estimated 250,000 Americans die each year from cardiac arrest suffered at public places such as a mall, sports stadium, or airport. Studies show that lay responders will use available automated external defibrillators (AEDs), which shock the heart back into normal rhythm, to revive cardiac arrest victims. The American Heart Association (AHA) recommends that AEDs be located in public places where there is a reasonable probability of one AED use in 5 years (20 percent annual probability of AED use). However, AEDs could be deployed at sites with only a 12 percent annual probability of AED use and still be cost effective, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 H00053).

Peter Cram, M.D., M.B.A., of the University of Iowa College of Medicine, and his colleagues used a decision model to compare two strategies at selected public locations in the United States. In the first strategy, individuals experiencing cardiac arrest were treated by emergency medical services personnel equipped with AEDs (EMS-D). In strategy 2, individuals were treated with AEDs deployed as part of a public access defibrillation program. Under strategy 1, cardiac arrest victims had a 10 percent probability of survival to hospital discharge, but they had a 25 percent probability under strategy 2 (based on an average time-to-shock interval of 4.5 minutes).

Under the base-case assumption that a deployed AED will be used on one cardiac arrest every 5 years, the cost per quality-adjusted life year (QALY) gained was $30,000 for AED deployment ($3,400 per site per year) compared with EMS-D care. AED deployment cost less than $50,000 per QALY gained (considered cost-effective for a medical intervention) even when the annual probability of AED use was only 12 percent or more.

More details are in "Cost-effectiveness of automated external defibrillator deployment in selected public locations," by Dr. Cram, Sandeep Vijan, M.D., M.S., and A. Mark Fendrick, M.D., in the September 2003 Journal of General Internal Medicine 18, pp. 745-754.

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