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Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest
Örebro University, Swedish Business School at Örebro University.
Department of Cardiology, Karolinska Institute, South Hospital, Stockholm.
Department of Cardiology, Karolinska Institute, South Hospital, Stockholm.
Department of Cardiology, Karolinska Institute, South Hospital, Stockholm.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

 

 

Aims: Out-of-hospital cardiac arrest (OHCA) is fatal without treatment,and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden.

 

 

 

Methods and Results:

 

A cost-benefit analysis was performed to evaluatethe effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (€ 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be € 13 000 and the cost per saved life was € 60 000.

 

Conclusions:

The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.

Keyword [en]
cost-benefit analysis, cost-utility analysis, cost-effectiveness analysis, out-of-hospital cardiac arrest, dual dispatch, defibrillation
National Category
Economics Social Sciences
Research subject
Economics
Identifiers
URN: urn:nbn:se:oru:diva-12611OAI: oai:DiVA.org:oru-12611DiVA: diva2:372877
Available from: 2010-12-01 Created: 2010-11-29 Last updated: 2016-11-21Bibliographically approved
In thesis
1. Economic evaluation, value of life, stated preference methodology and determinants of risks
Open this publication in new window or tab >>Economic evaluation, value of life, stated preference methodology and determinants of risks
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The first paper examines the value of a statistical life (VSL) for out-of-hospital cardiac arrest (OHCA) victims. We found VSL values to be higher for OHCA victims than for people who die in road traffic accidents and a lower-bound estimate of VSL for OHCA would be in the range of 20 to 30 million Swedish crowns (SEK).

The second paper concerns hypothetical bias in contingent valuation (CV) studies. We investigate the link between the determinants and empirical treatment of uncertainty through certainty calibration and find that the higher the confidence of the respondents the more we can trust that stated WTP is correlated to actual WTP.

The third paper investigates the performance of two communication aids (a flexible community analogy and an array of dots) in valuing mortality risk reductions for OHCA. The results do not support the prediction of expected utility theory, i.e. that WTP for a mortality risk reduction increases with the amount of risk reduction (weak scope sensitivity), for any of the communication aids.

The fourth paper presents a cost-benefit analysis to evaluate the effects of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm. The intervention had positive economic effects, yielding a benefit-cost ratio of 36, a cost per quality-adjusted life-year (QALY) of € 13 000 and the cost per saved life was € 60 000.

The fifth paper explores how different response times from OHCA to defibrillation affect patients’ survival rates by using geographic information systems (GIS). The model predicted a baseline survival rate of 3.9% and reducing the ambulance response time by 1 minute increased survival to 4.6%.

The sixth paper analyzes demographic determinants of incident experience and risk perception, and the relationship between the two, for eight different risk domains. Males and highly educated respondents perceive their risks lower than what is expected compared to actual incident experience.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2010. 46 p.
Series
Örebro Studies in Economics, ISSN 1651-8896 ; 21
Keyword
Cost-benefit analysis, value of a statistical life, contingent valuation, cardiac arrest, defibrillation, calibration, sensitivity to scope, risk communication, response times, incident experience, risk perception.
National Category
Social Sciences Economics
Research subject
Economics
Identifiers
urn:nbn:se:oru:diva-12557 (URN)978-91-7668-775-8 (ISBN)
Public defence
2011-01-14, Hörsal Musik, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15
Opponent
Supervisors
Available from: 2010-11-24 Created: 2010-11-24 Last updated: 2011-04-21Bibliographically approved

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