Cost-effectiveness analysis of termination-of-resuscitation rules for patients with out-of-hospital cardiac arrest

被引:4
|
作者
Shibahashi, Keita [1 ,2 ]
Konishi, Takaaki [1 ]
Ohbe, Hiroyuki [1 ]
Yasunaga, Hideo [1 ]
机构
[1] Univ Tokyo, Sch Publ Hlth, Dept Clin Epidemiol & Hlth Econ, 7-3-1 Hongo,Bunkyo Ku, Tokyo 1130033, Japan
[2] Tokyo Metropolitan Bokutoh Hosp, Tertiary Emergency Med Ctr, 4-23-15 Kotobashi,Sumida Ku, Tokyo 1308575, Japan
关键词
Out-of-hospital cardiac arrest; Termination of resuscitation; Cost-effectiveness; Health economics; CEREBRAL PERFORMANCE CATEGORY; ASSOCIATION; SURVIVAL; STROKE; CARE;
D O I
10.1016/j.resuscitation.2022.09.006
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: To evaluate the cost-effectiveness of practices with and without termination-of-resuscitation (TOR) rules for out-of-hospital cardiac arrest (OHCA), using an analytic model based on a nationwide population-based registry in Japan. Methods: A combined model using a decision tree and Markov model was developed to compare costs and treatment effectiveness of three scenarios: basic life support (BLS) TOR rules (BLS-rule scenario), advanced life support (ALS) TOR rules (ALS-rule scenario), and no TOR rules (No-rule scenario). A nationwide population-based OHCA registry from January 1 to December 31, 2019 and published data were used. Analyses were performed from healthcare payers' perspectives. Life-time incremental cost-effectiveness ratio (ICER) was determined by the difference in cost between two scenarios, divided by the difference in quality adjusted life year (QALY). Results: The OHCA registry included 126,271 patients (57.3% men; median age, 80 years). The BLS-rule scenario yielded lower cost and less QALY than the ALS-rule scenario and No-rule scenario. With reference to the BLS-rule scenario, the ICERs for the ALS-rule scenario and No-rule scenario were 81,000 and 98,762 USD per QALY, respectively. The BLS-rule scenario was cost-effective in 100% of simulations at the willingness-to-pay threshold in Japan (5 million JPY = 45,455 USD). The willingness-to-pay threshold higher than 80,000 and 204,000 USD were required for the ALS-rule scenario and No-rule scenarios, respectively, to be cost-effective. Conclusion: No-rule scenario was not cost-effective compared with BLS-rule scenario within acceptable willingness-to-pay thresholds. Further research on health economics of TOR rules is warranted to support constructive discussion on implementing TOR rules.
引用
收藏
页码:45 / 51
页数:7
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