Estimation of Health and Economic Benefits of a Small Automatic External Defibrillator for Rapid Treatment of Sudden Cardiac Arrest (SMART): A Cost-Effectiveness Analysis.

Marcus S Shaker,Alexander G Singer,Matthew Greenhawt,John Oppenheimer,Daniel Fleck,Matthew Shaker,Evan Grove,Elissa M Abrams

doi:10.3389/fcvm.2022.771679

Abstract

BackgroundSudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. Early CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited.MethodsMarkov models were used to evaluate the cost-effectiveness of a portable SMART (SMall AED for Rapid Treatment of SCA) approach to early SCA management over a life-time horizon in at-risk and not at-risk populations. Simulated patients (n = 600,000) who had not received an implantable cardioverter defibrillator (ICD) were randomized to a SMART device with CPR prompts or non-SMART approaches. Annual SCA risk was varied from 0.2 to 3.5%. Analysis was performed in a US economy from both societal (SP) and healthcare (HP) perspectives to evaluate the number of SCA fatalities prevented by SMART, and SMART cost-effectiveness at a threshold of $100,000/Quality Adjusted Life Year (QALY).ResultsA SMART approach was cost-effective when annual SCA risk exceeded 1.51% (SP) and 1.62% (HP). The incremental cost-effectiveness ratios (ICER) were $95,251/QALY (SP) and $100,797/QALY (HP) at a 1.60% SCA annual risk. At a 3.5% annual SCA risk, SMART was highly cost-effective from both SP and HP [ICER: $53,925/QALY (SP), $59,672/QALY (HP)]. In microsimulation, SMART prevented 1,762 fatalities across risk strata (1.59% fatality relative risk reduction across groups). From a population perspective, SMART could prevent at least 109,839 SCA deaths in persons 45 years and older in the United States.Conclusions and RelevanceA SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk. The availability of a smart-phone enabled pocket-sized AED with CPR prompts has the potential to greatly improve population health and economic outcomes.

Highlights

Every day, almost 1,000 people experience sudden cardiac arrest (SCA) in the United States with a staggering 90% fatality rate [1]
From a societal perspective (SP), sudden cardiac death (SCD) in the United States results in an estimated 2 million years of potential life lost for men and 1.3 million years for women [2]
At a 1.6% annual SCA risk, the incremental cost-effectiveness ratio (ICER) associated with a small automatic external defibrillators (AEDs) for rapid treatment of SCA (SMART) strategy was $95,251/quality-adjusted life year (QALY) (SP) and $100,797/QALY (HP)

Summary

Introduction

Almost 1,000 people experience sudden cardiac arrest (SCA) in the United States with a staggering 90% fatality rate [1]. SCD and arrhythmia account for 15–20% of all deaths with the majority occurring in patients without cardiac risk factors [3]. Cardiovascular disease is a leading cause of global mortality, accounting for almost 17 million deaths annually. In developing countries, it causes twice as many deaths as HIV, malaria and TB combined. Sudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited

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