Cost-effectiveness of automated external defibrillator deployment in selected public locations

J Gen Intern Med. 2003 Sep;18(9):745-54. doi: 10.1046/j.1525-1497.2003.21139.x.


Objective: The American Heart Association (AHA) recommends an automated external defibrillator (AED) be considered for a specific location if there is at least a 20% annual probability the device will be used. We sought to evaluate the cost-effectiveness of the AHA recommendation and of AED deployment in selected public locations with known cardiac arrest rates.

Design: Markov Decision Model employing a societal perspective.

Setting: Selected public locations in the United States.

Patients: A simulated cohort of the American public.

Intervention: Strategy 1: individuals experiencing cardiac arrest were treated by emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals were treated with AEDs deployed as part of a public access defibrillation program. Strategies differed only in the initial availability of an AED and its impact on cardiac arrest survival.

Results: Under the base-case assumption that a deployed AED will be used on 1 cardiac arrest every 5 years (20% annual probability of AED use), the cost per quality-adjusted life year (QALY) gained is $30,000 for AED deployment compared with EMS-D care. AED deployment costs less than $50,000 per QALY gained provided that the annual probability of AED use is 12% or greater. Monte Carlo simulation conducted while holding the annual probability of AED use at 20% demonstrated that 87% of the trials had a cost-effectiveness ratio of less than $50,000 per QALY.

Conclusions: AED deployment is likely to be cost-effective across a range of public locations. The current AHA guidelines are overly restrictive. Limited expansion of these programs can be justified on clinical and economic grounds.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Electric Countershock / economics*
  • Electric Countershock / statistics & numerical data*
  • Emergency Medical Services / economics*
  • Emergency Medical Services / statistics & numerical data*
  • Emergency Treatment / instrumentation*
  • Equipment and Supplies / supply & distribution
  • Humans
  • Markov Chains
  • United States