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

J Gen Intern Med. 2005 Mar;20(3):251-8. doi: 10.1111/j.1525-1497.2005.40247.x.

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 dollars. 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 dollars, 104,000 dollars, and 88,000 dollars, 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.

MeSH terms

  • Cost-Benefit Analysis
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / prevention & control*
  • Decision Support Techniques*
  • Defibrillators / economics*
  • Emergency Medical Services / economics
  • Home Care Services / economics
  • Humans
  • Life Expectancy
  • Markov Chains
  • Monte Carlo Method
  • Quality-Adjusted Life Years
  • Risk Factors
  • United States