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首页> 美国卫生研究院文献>British Medical Journal >Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest
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Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest

机译：公共场所除颤器改善院前心肺骤停后生存的成本效益和成本效用模型

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>Objective To determine the cost effectiveness and cost utility of locating defibrillators in all major airports, railway stations, and bus stations throughout Scotland.>Design Economic modelling exercise with data from Heartstart (Scotland). Parameters used in economic model included direct costs derived for increased accident and emergency attendances, increased hospital bed days, purchase and maintenance of defibrillators, and training in their use; life years gained calculated from increased discharges from hospital and mean survival after discharge; utility (quality of life) obtained from published data. Sensitivity analyses tested the robustness of model. Future gains discounted at 1.5% a year and future costs at 6%.>Setting Whole of Scotland.>Subjects Records of all prehospital cardiac arrests due to presumed heart disease that occurred in a major airport, railway, or bus station between May 1991 and March 1998 and were not witnessed by ambulance or medical staff.>Main outcome measures Observed survival to hospital admission and observed survival to discharge. Predicted survival calculated by applying observed survival in patients attended by ambulance staff within three minutes to those who waited longer.>Results The total discounted direct costs were £18 325 a year. The cost per life year gained was £29 625 ($49 625, €43 151) and the cost per quality adjusted life year (QALY) gained was £41 146 ($68 924, €59 932). More widespread provision of public place defibrillators would increase these figures.>Conclusions The cost per QALY calculated for public place defibrillators represents poorer value for money than some alternative strategies for improving survival after prehospital cardiopulmonary arrest, such as the use of other trained first responders. The figure exceeds the commonly discussed cut off levels for funding in the United Kingdom and United States of £30 000 and $50 000 per QALY, respectively.
机译：>目的，以确定在苏格兰所有主要机场，火车站和汽车站内安装除颤器的成本效益和成本效用。>设计经济建模活动，采用Heartstart（苏格兰）的数据）。经济模型中使用的参数包括：因事故和紧急情况出勤增加，病床天数增加，除颤器的购买和维护以及使用培训而产生的直接费用；通过增加出院量和出院后的平均生存期计算得出的生命年；从发布的数据中获得的效用（生活质量）。敏感性分析测试了模型的鲁棒性。未来收益每年折现1.5％，未来成本折现6％。>设置整个苏格兰。>主题记录所有因在医院内发生的假定的心脏病而导致的院前心脏骤停的记录。在1991年5月至1998年3月之间的主要机场，铁路或汽车站，并且没有被救护车或医务人员目击。>主要结果指标观察医院入院生存率和出院生存率。通过将在三分钟内由救护人员陪护的患者中观察到的存活率与等待时间更长的患者的存活率相乘来计算预期的存活率。>结果，直接总折算成本为每年18325英镑。每个生命年的成本为29 625英镑（49 625美元，43 151欧元），每个质量调整生命年（QALY）的成本为41 146英镑（68 924美元，59932欧元）。 >结论为公共场所除颤器计算出的每QALY成本，与某些提高院前心肺骤停后生存率的替代策略（例如使用）相比，其物有所值价值较差。其他训练有素的急救人员。该数字超过了英国和美国通常讨论的每QALY的分界线分别为3万英镑和5万美元。

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