Abstract 216: A Sensitivity Analysis of Incremental Cost-Effectiveness Ratio of the Nationwide Public Access Defibrillation Program in Japan

Abstract

Introduction: We have previously estimated the cost of and quality-adjusted life year (QALY) gained with ~200,000 AEDs placed in Japan between 2004 through 2009, and reported that the maximum likelihood estimate (MLE) of the incremental cost-effectiveness ratio (ICER) to be ~$93,980/QALY. To evaluate the robustness of the estimated ICER, we conducted a sensitivity analysis using Monte Carlo simulation. Methods: Over the study period, 3,927 patients received public access defibrillation (PAD). A control group was created by extracting, from the national database, another group of 3,927 cardiac arrest patients who did not receive PADs but otherwise matched with regard to confounders including age, sex, response time and others. The difference of the total QALY in the 2 groups yielded incremental effectiveness gained by the PAD program. The sum of the total cost for AED purchase and maintenance, cost of BLS training for first responders, and differential cost for medical care yielded the incremental cost. The value for each variable needed to calculate the incremental cost and effectiveness was randomly varied in such a way that followed the pre-defined probability density function (Table). Monte Carlo simulation was repeated 10,000 times to estimate the MLE and its 95% CI for ICER. Results: The MLE (95% CI) for the incremental cost and incremental effectiveness was ~$ 580 million (577- 583 million) and ~7,559 (6,298- 8,858) QALY, yielding ICER of $77,320 ($65,503- 92,017) /QALY (figure). Conclusions: Our estimate of the ICER seemed to be relatively robust to several assumptions. The ICER of the whole Japan PAD program seemed to be higher than desirable but still acceptable.