This Article Full Text Full Text (PDF) All Versions of this Article: 110/14/1967    most recent 01.CIR.0000143150.13727.19v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by van Alem, A. P. Articles by Koster, R. W. Search for Related Content PubMed PubMed Citation Articles by van Alem, A. P. Articles by Koster, R. W. Pubmed/NCBI databases Medline Plus Health Information Emergency Medical Services Related Collections CPR and emergency cardiac care

(Circulation. 2004;110:1967-1973.)
© 2004 American Heart Association, Inc.

Health Services and Outcomes Research

Health System Costs of Out-of-Hospital Cardiac Arrest in Relation to Time to Shock

From the Department of Cardiology (A.P.v.A., J.G.P.T., R.W.K.) and Department of Clinical Epidemiology and Biostatistics (M.G.W.D.), Academic Medical Center, Amsterdam, the Netherlands.

Correspondence to A.P. van Alem, MD, PhD, Academic Medical Center, Department of Cardiology, Room F3-241, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. E-mail a.p.vanalem{at}amc.uva.nl

Received March 16, 2004; revision received June 17, 2004; accepted June 18, 2004.

Background— Early defibrillation results in higher admission rates and healthcare costs. This study determined the healthcare resources used and related medical costs after out-of-hospital cardiac arrest (OHCA) in relation to time to shock. We assessed the incremental healthcare costs per life gained from reduction in time to shock of 2, 4, and 6 minutes.

Methods and Results— Clinical and costs data of patients in witnessed OHCA with ventricular fibrillation as initial rhythm were collected. Each patient’s time to shock was estimated and assigned to 1 of 3 categories: 7 minutes (early), 7 to 12 minutes (intermediate), and >12 minutes (late). Incremental cost-effectiveness analysis and Monte Carlo simulation compared scenarios of reduction in time to shock of 2, 4, and 6 minutes. Six-month survival was 22%. Mean prehospital, in-hospital, and posthospital costs in the first half-year after OHCA were 559, 6869 and 666. Mean costs were 28 636 per survivor and 2384 per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20 253. Of the intermediate group (n=149), 26% survived, with costs averaging 31 467. Among patients shocked late (n=135), 13% survived, with costs averaging 27 781. The point estimates of the incremental cost-effectiveness ratios of reduction of time to shock of 2, 4, and 6 minutes compared with baseline were 17 508, 14 303, and 12 708 per life saved, respectively.

Conclusions— Costs per survivor were lowest with the shortest time to shock because of shorter stay in the intensive care unit. Reducing the time to defibrillation increases the healthcare costs by an acceptable amount according to current standards and is economically attractive.

Key Words: resuscitation • defibrillation • cost-benefit analysis • heart arrest

This article has been cited by other articles:

				A. Ringborg, R. Nieuwlaat, P. Lindgren, B. Jonsson, D. Fidan, A. P. Maggioni, J. Lopez-Sendon, J. Stepinska, D. V. Cokkinos, and H. J.G.M. Crijns Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation Europace, April 1, 2008; 10(4): 403 - 411. [Abstract] [Full Text] [PDF]