Cost-effectiveness analysis of an ambulance service-operated specialised cardiac vehicle with mobile extracorporeal cardiopulmonary resuscitation capacity for out-of-hospital cardiac arrests in Queensland, Australia

IF 1.7 4区医学 Q2 EMERGENCY MEDICINE Emergency Medicine Australasia Pub Date : 2024-05-28 DOI:10.1111/1742-6723.14447

Tan N Doan PhD, Stephen Rashford MBBS, FACEM, Emma Bosley PhD

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Abstract

Objective

Extracorporeal CPR (E-CPR) has been primarily limited to the in-hospital setting. A few systems around the world have implemented pre-hospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians required for the performance of E-CPR on-scene. However, evidence of the outcomes and cost-effectiveness of mobile E-CPR remain to be established. We evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service in the state of Queensland, Australia.

Methods

We adapted our published mathematical model to estimate the cost-effectiveness of pre-hospital mobile E-CPR relative to current practice. In the model, a specialised cardiac vehicle with mobile E-CPR capability is deployed to selected OHCA patients, with eligible candidates receiving pre-hospital E-CPR in-field and rapid transport to the closest appropriate centre for in-hospital E-CPR. For comparison, non-candidates receive standard ACLS from a conventional ambulance response. Cost-effectiveness was expressed as Australian dollars ($, 2021 value) per quality-adjusted life year (QALY) gained.

Results

Pre-hospital mobile E-CPR improves outcomes compared to current practice at a cost of $27 323 per QALY gained. The cost-effectiveness of pre-hospital mobile E-CPR is sensitive to the assumption around the number of patients who are the targets of the vehicle, with higher patient volume resulting in improved cost-effectiveness.

Conclusions

Pre-hospital E-CPR may be cost-effective. Successful implementation of a pre-hospital E-CPR programme requires substantial planning, training, logistics and operational adjustments.

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对澳大利亚昆士兰州院外心脏骤停救护服务运营的具有移动体外心肺复苏能力的心脏专车进行成本效益分析。

目的：体外心肺复苏（E-CPR）主要局限于院内环境。世界上已有少数系统实施了院前移动式心肺复苏术，其形式为配备有现场实施心肺复苏术所需的专用设备和临床医生的专用心脏车。然而，有关移动 E-CPR 的效果和成本效益的证据仍有待确定。我们对澳大利亚昆士兰州昆士兰救护中心运营的假想移动式 E-CPR 车的成本效益进行了评估：我们对已发布的数学模型进行了调整，以估算院前移动式 E-CPR 相对于当前实践的成本效益。在该模型中，一辆具有移动 E-CPR 功能的心脏专车被部署到选定的 OHCA 患者处，符合条件的患者在现场接受院前 E-CPR 并被快速运送到最近的适当中心进行院内 E-CPR。作为对比，非候选者则接受传统救护车响应的标准 ACLS。成本效益以每个质量调整生命年（QALY）获得的澳元（$，2021 年值）表示：结果：与目前的做法相比，院前移动 E-CPR 可改善预后，每获得一个质量调整生命年的成本为 27 323 澳元。院前移动 E-CPR 的成本效益对车辆目标患者人数的假设很敏感，患者人数越多，成本效益越高：院前 E-CPR 可能具有成本效益。院前 E-CPR 计划的成功实施需要大量的规划、培训、后勤和操作调整。

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来源期刊

Emergency Medicine Australasia 医学-急救医学

CiteScore

3.70

自引率

13.00%

发文量

217

审稿时长

6-12 weeks

期刊介绍： Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.