Estimates of cost-effectiveness of prehospital continuous positive airway pressure in the management of acute pulmonary edema

Prehosp Emerg Care. 2008 Jul-Sep;12(3):277-85. doi: 10.1080/10903120801949275.


Objective: To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system.

Methods: Using estimates from published reports on prehospital and emergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate and multivariate sensitivity analyses was performed on the input variables.

Results: The cost of consumables, equipment, and training yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients and is expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications and reduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions.

Conclusion: Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs and clinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.

Publication types

  • Meta-Analysis

MeSH terms

  • Acute Disease
  • Continuous Positive Airway Pressure / economics*
  • Cost-Benefit Analysis
  • Emergency Medical Services / economics*
  • Emergency Medical Technicians
  • Health Care Costs*
  • Hospitalization / economics
  • Humans
  • Models, Econometric
  • Multivariate Analysis
  • Pulmonary Edema / economics
  • Pulmonary Edema / therapy*
  • United States
  • Urban Health Services