Open AccessCost‐effectiveness of In‐home Automated External Defibrillators for Individuals at Increased Risk of Sudden Cardiac Death
Author(s) -
Cram Peter,
Vijan Sandeep,
Katz David,
Fendrick A. Mark
Publication year - 2005
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1111/j.1525-1497.2005.40247.x
Subject(s) - medicine , sudden cardiac death , myocardial infarction , sudden cardiac arrest , emergency medical services , emergency medicine , medical emergency
Background/Objective: In‐home automated external defibrillators (AEDs) are increasingly recommended as a means for improving survival of cardiac arrests that occur at home. The current study was conducted to explore the relationship between individuals' risk of cardiac arrest and cost‐effectiveness of in‐home AED deployment. Design: Markov decision model employing a societal perspective. Patients: Four hypothetical cohorts of American adults 60 years of age at progressively greater risk for sudden cardiac death (SCD): 1) all adults (annual probability of SCD 0.4%); 2) adults with multiple SCD risk factors (probability 2%); 3) adults with previous myocardial infarction (probability 4%); and 4) adults with ischemic cardiomyopathy unable to receive an implantable defibrillator (probability 6%). Intervention: Strategy 1: individuals suffering an in‐home cardiac arrest were treated with emergency medical services equipped with AEDs (EMS‐D). Strategy 2: individuals suffering an in‐home cardiac arrest received initial treatment with an in‐home AED, followed by EMS. Results: Assuming cardiac arrest survival rates of 15% with EMS‐D and 30% with AEDs, the cost per quality‐adjusted life‐year gained (QALY) of providing in‐home AEDs to all adults 60 years of age is $216,000. Costs of providing in‐home AEDs to adults with multiple risk factors (2% probability of SCD), previous myocardial infarction (4% probability), and ischemic cardiomyopathy (6% probability) are $132,000, $104,000, and $88,000, respectively. Conclusions: The cost‐effectiveness of in‐home AEDs is intimately linked to individuals' risk of SCD. However, providing in‐home AEDs to all adults over age 60 appears relatively expensive.