Abstract
ObjectivesThis research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective?SettingA single National Health Service ambulance service and a charity-funded prehospital critical care service in England.ParticipantsThe patient population is adult, non-traumatic OHCA.MethodsWe combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.ResultsCosts of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%.ConclusionThis is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive. Knowledge of the MEID for prehospital critical care can guide future research in this field.Trial registration numberISRCTN18375201
Highlights
Rates of survival following out-of-hospital cardiac arrest (OHCA) remain low in the UK, with an overall survival rate to hospital
In the absence of robust data regarding the effectiveness of prehospital advanced life support (ALS) or critical care for OHCA in the UK setting, this study addresses the following questions: ►► What are the costs of prehospital ALS and prehospital care for OHCA in the UK? ►► What is the cost-effectiveness of the current OHCA
Based on literature referenced in the sections below, important assumptions are that ►► A proportion of patients survive to hospital arrival but receive palliative care only, resulting in death in the emergency department or shortly afterwards. ►► Patients who survive to hospital discharge with Cerebral Performance Category (CPC) scores of 3–4 have a higher rate of survival following the first 5 years after hospital discharge, compared with those patients surviving with CPC scores of 1–2. ►► After 5 years postdischarge, annual survival rates for patients still alive at this point are the same as those of the average population
Summary
This research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for outof-hospital cardiac arrest (OHCA)? What is the costeffectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective? Setting A single National Health Service ambulance service and a charity-funded prehospital critical care service in England. This research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for outof-hospital cardiac arrest (OHCA)? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective? When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive.
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