Abstract
BackgroundEVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services.MethodsAn accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation.ResultsSimulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1.ConclusionsEVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.
Highlights
EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA)
The aim of the current study was to simulate the potential increase in annual survival from witnessed OHCA of cardiac origin, and the decreased costs per QALY, associated with a more efficient use of the yet existing resources (i.e. basic life support (BLS)-trained volunteers and public AED), upon nation-wide EVapp implementation in Belgium
It was estimated that the amount of QALY gained by implementation of EVapp, following 6 years of long-term mean survival after OHCA, was up to 910 QALY (Fig. 3)
Summary
EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). Previous studies have been conducted on the clinical benefits and cost-effectiveness of public access defibrillation (PAD) programs, aimed at increasing the use of AED, prior to EMS-arrival [19, 20]. Comparison of such programs is challenging, considering the high degree of heterogeneity in the types of programs implemented (e.g., static vs mobile AED use, strategy for activation, defibrillation by professionals, the public, or combinations of both) and the context within which they operate (baseline availability of public AED, overall chain of survival and level of care, geographic variations, socio-economic disparities) [20, 21]. Previous civilian-based resuscitation initiatives, activating volunteers via a mobile phone application [25,26,27,28,29], have underscored the importance of increased rates of early BLS and/or use of public AED, even achieving survival to discharge rates of 40–50% [28]
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