Cardiac arrest: a 2-tier response system was cost-effective for improving survival

Clinical bottom line (level 1b)

  1. The most cost-effective measures for improving survival for out-of-hospital cardiac arrests were
    • implementing a 2-tier response system if a one-tier system is in operation
    • reducing response times in a 2-tier system by providing more BLS providers in fire-trucks
Nichol et al: Annals of Emergency Medicine 1996; 27 (6): 711-720
Expires November 2002

The study

cost-effectiveness analysis
Setting: urban communities, North America

A decision analysis created using information from a systematic review and meta-analysis of 41 case series of out-of-hospital cardiac arrest

  • Viewpoint: society
  • Benefit assessment: survival to discharge
  • Resources and costs: Costs in 1993 US dollars - the system component costs were taken from emergency medical service in Ontario, Canada from 1991 fiscal year, using a standard discount rate of 5% for equipment and adjusted for inflation. Future or indirect costs were not calculated.
  • Sensitivity analysis: The proportion of bystander CPR, response time interval, EMS tier, survival during hospitalisation, long-term survival, utility and cost components were varied.

    • The evidence

    intervention cost
    change from 1-tier to 2-tier system by providing BLS providers in fire trucks 40000
    ( per QALY )
    2-tier system: addition of BLS providers in fire trucks to reduce response time by 1 minute 53000
    ( per QALY )
    change from 1-tier to 2-tier system by providing BLS providers in ambulances for the first-tier 94000
    ( per QALY )
    2-tier system: addition of more BLS providers in ambulances in the first-tier to reduce response time by 1 minute 159000
    ( per QALY )
    1-tier system: additional EMS providers in ambulances to reduce response time by 1 minute 368 000
    ( per QALY )

    Effect of sensitivity analysis: The incremental cost-effectiveness analysis were found to be relatively robust to large changes in the sensitivity analysis.

    Comments

    1. A 1-tier system consists of ALS providers in ambulances; a 2-tier system consists of BLS providers in fire trucks, ambulances or vans, supported by ALS providers in ambulances

    Citation

    1. Nichol G, Laupacis A, Stiell IG, et al: cost-effectiveness analysis of potential improvements to emergency medical services for victims of out-of-hospital cardiac arrest. Annals of Emergency Medicine 1996; 27 (6): 711-720
    Search Terms: arrest in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient society
    Intervention or Exposure administration systems for out-of hospital cardiac arrest
    Outcome cost-effectiveness