Cost-effectiveness of In-home Automated External Defibrillators for Individuals at Increased Risk of Sudden Cardiac Death

There's No Place Like Home?

Authors

  • Peter Cram MD, MBA,

    1. Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA
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  • Sandeep Vijan MD, MS,

    1. Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
    2. Ann Arbor Veterans Affairs Health Services Research and Development Field Program, Ann Arbor, MI, USA
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  • David Katz MD, MSc,

    1. Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA
    2. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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  • A. Mark Fendrick MD

    1. Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
    2. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
    3. Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, MI, USA.
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  • The authors do not have any conflicts of interest to declare for this work. These results were presented at the 27th annual meeting of the Society of General Internal Medicine, May 12–15, 2004, Chicago, IL.

Address correspondence and requests for reprints to Dr. Cram: Division of General Medicine, 200 Hawkins Drive, 6SE GH, University of Iowa Hospitals and Clinics, Iowa City, IA 52240 (e-mail: peter-cram@uiowa.edu).

Abstract

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.

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