Automated external defibrillators are cost-effective on large and medium capacity commercial aircraft

Marenco, Dr J. P.

New England Medical Center, Boston, USA

Abstracted from:Groeneveld PW, Kwong JL, Liu Y, Rodriguez AJ, Jones MP, Sanders GD, Garber AM. Cost-effectiveness of automated external defibrillators on airlines. JAMA 2001; 286: 1482-1489 .

Evidence-based Healthcare 6(2):p 58-59, June 2002.

BACKGROUND

Automated external defibrillators can improve cardiac arrest survival rates in non-hospital contexts when used by trained emergency and lay personnel. Survival rates on commercial aircraft with automated defibrillators have improved at a cost of $300,000 per life saved. The cost-effectiveness of mandatory implementation of automated external defibrillators on commercial airlines remains uncertain.

OBJECTIVE

To conduct a cost-effectiveness analysis of automated external defibrillator use on passenger air-craft.

SETTING

United States, 2001.

METHOD

Cost-effectiveness analysis.

LITERATURE REVIEW

MEDLINE search (1966 to 2000) for studies including the keywords defibrillation, defibrillator, cost and economic. Three hundred and eleven studies were identified. Three were cost-effectiveness analyses of automated external defibrillators, but only one study examined a specialised, chronic-care setting.

ANALYSIS

A decision-analytic model was used with Markov processes to pinpoint short and long-term costs and benefits of automated external defibrillators after cardiac arrest. A hypothetical cohort of cardiac arrest cases on US commercial aircraft were tracked over 1 year.

OUTCOMES

Cost per quality-adjusted life-year gained; survival rates; survivor outcomes; quality of life for survivors; costs to airlines. US dollars are used for cost estimates.

MAIN RESULTS

Automated external defibrillator use on all passenger aircraft would save an estimated 33 lives per year and cost US$94,700 per quality-adjusted life-year gained (95% CI US$58,300 to $166,500). On larger aircraft (capacity over 200 people), seven lives per year would be saved costing US$35,300 per quality-adjusted life-year gained (95% CI US$11,400 to $74,800).

AUTHORS' CONCLUSIONS

Use of automated external defibrillators on large and medium capacity commercial aircraft is cost-effective. Cost-effectiveness for smaller aircraft is uncertain.