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Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7427.1316 (Published 04 December 2003) Cite this as: BMJ 2003;327:1316
  1. Andrew Walker, senior lecturer in health economics1,
  2. Jane M Sirel, research assistant2,
  3. Andrew K Marsden, medical director3,
  4. Stuart M Cobbe, Walton professor of medical cardiology2,
  5. Jill P Pell, consultant in public health medicine (jill.pell{at}gghb.scot.nhs.uk)4
  1. 1Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ
  2. 2Department of Medical Cardiology, University of Glasgow, Glasgow G32 2ER
  3. 3Scottish Ambulance Service Headquarters, Edinburgh EH10 5UU
  4. 4Greater Glasgow NHS Board, Glasgow G3 8YZ
  1. Correspondence to: J Pell
  • Accepted 30 September 2003

Abstract

Objective To determine the cost effectiveness and cost utility of locating defibrillators in all major airports, railway stations, and bus stations throughout Scotland.

Design Economic modelling exercise with data from Heartstart (Scotland). Parameters used in economic model included direct costs derived for increased accident and emergency attendances, increased hospital bed days, purchase and maintenance of defibrillators, and training in their use; life years gained calculated from increased discharges from hospital and mean survival after discharge; utility (quality of life) obtained from published data. Sensitivity analyses tested the robustness of model. Future gains discounted at 1.5% a year and future costs at 6%.

Setting Whole of Scotland.

Subjects Records of all prehospital cardiac arrests due to presumed heart disease that occurred in a major airport, railway, or bus station between May 1991 and March 1998 and were not witnessed by ambulance or medical staff.

Main outcome measures Observed survival to hospital admission and observed survival to discharge. Predicted survival calculated by applying observed survival in patients attended by ambulance staff within three minutes to those who waited longer.

Results The total discounted direct costs were £18 325 a year. The cost per life year gained was £29 625 ($49 625, €;43 151) and the cost per quality adjusted life year (QALY) gained was £41 146 ($68 924, €;59 932). More widespread provision of public place defibrillators would increase these figures.

Conclusions The cost per QALY calculated for public place defibrillators represents poorer value for money than some alternative strategies for improving survival after prehospital cardiopulmonary arrest, such as the use of other trained first responders. The figure exceeds the commonly discussed cut off levels for funding in the United Kingdom and United States of £30 000 and $50 000 per QALY, respectively.

Footnotes

  • Contributors JPP had the original idea for the study and drafted and revised the manuscript. JPP and JMS calculated the observed and predicted survival figures. AW undertook the economics analyses. JPP and AW interpreted the results. AKM provided information on costs of buying defibrillators and training. All authors read and approved the final version. SMC manages the Heartstart register. JPP is the guarantor

  • Funding British Heart Foundation

  • Competing interests None declared.

  • Ethical approval Not required.

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