Estimation of Health and Economic Benefits of a Small Automatic External Defibrillator for Rapid Treatment of Sudden Cardiac Arrest (SMART): A Cost-Effectiveness Analysis.

Background

Sudden cardiac arrest (SCA) occurs in 0.4% of the general population and up to 6% or more of at-risk groups each year. Early CPR and defibrillation improves SCA outcomes but access to automatic external defibrillators (AEDs) remains limited.

Methods

Markov models were used to evaluate the cost-effectiveness of a portable SMART (SMall AED for Rapid Treatment of SCA) approach to early SCA management over a life-time horizon in at-risk and not at-risk populations. Simulated patients (

Results

A SMART approach was cost-effective when annual SCA risk exceeded 1.51% (SP) and 1.62% (HP). The incremental cost-effectiveness ratios (ICER) were $95,251/QALY (SP) and $100,797/QALY (HP) at a 1.60% SCA annual risk. At a 3.5% annual SCA risk, SMART was highly cost-effective from both SP and HP [ICER: $53,925/QALY (SP), $59,672/QALY (HP)]. In microsimulation, SMART prevented 1,762 fatalities across risk strata (1.59% fatality relative risk reduction across groups). From a population perspective, SMART could prevent at least 109,839 SCA deaths in persons 45 years and older in the United States.

Conclusions and Relevance

A SMART approach to SCA prophylaxis prevents fatalities and is cost-effective in patients at elevated SCA risk. The availability of a smart-phone enabled pocket-sized AED with CPR prompts has the potential to greatly improve population health and economic outcomes.

Informations de copyright

Copyright © 2022 Shaker, Abrams, Oppenheimer, Singer, Shaker, Fleck, Greenhawt and Grove.

Déclaration de conflit d'intérêts

MSS has a family member who is employed by Altrix Medical, is a member of the Joint Taskforce on Allergy Practice Parameters, and serves as a member of the editorial boards of the Journal of Allergy and Clinical Immunology in Practice, the Annals of Allergy, Asthma, and Immunology, and the Journal of Food Allergy. EA is an employee of Public Health Agency of Canada (PHAC); the views expressed in this article are hers and not that of PHAC. JO declares the following: Research/Adjudication: AZ, GSK, Sanofi, Novartis; Consultant: GSK, AZ, Sanofi; Associate Editor: Annals of Allergy Asthma Immunology, AllergyWatch; Section Editor: Current Opinion of Allergy; Royalties: Up to Date; Board Liaison ABIM for ABAI. MS holds a patent related to a smart-phone enabled small AED and is employed by Altrix Medical. DF is employed by Altrix Medical. Altrix Medical's Smart AED is supported by the National Science Foundation under Grant No. 1842149 and under Cooperative Agreement No. 2026090. MG was supported by grant #5K08HS024599-02 from the Agency for Healthcare Quality and Research during the preparation of this manuscript; is an expert panel and coordinating committee member of the NIAID-sponsored Guidelines for Peanut Allergy Prevention; has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory boards for Aimmune Therapeutics, DBV Technologies, Sanofi/Genzyme, Genentech, Nutricia, Novatris, Kaleo Pharmaceutical, Nestle, Acquestive, Allergy Therapeutics, Pfizer, US World Meds, Allergenis, Aravax, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, Before Brands, multiple state allergy societies, the ACAAI, the EAACI; is an associate editor for the Annals of Allergy, Asthma, and Immunology; and is a member of the Joint Taskforce on Allergy Practice Parameters. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.