Background: Despite a consistent association with improved outcomes, public automated external defibrillators (AEDs) are rarely used in out-ofhospital cardiac arrest. One of the barriers towards increased use might be cost-effectiveness. Methods: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the United States over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Results: The no AED strategy resulted in 1.63 QALYs at a cost of $28,964. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. In several sensitivity analyses across a plausible range of health care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a willingness-to-pay threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion:PublicAEDs are a cost-effective public health intervention in the UnitedStates.These findings support widespread dissemination of public AEDs.

Additional Metadata
Keywords Cardiac arrest, Cardiopulmonary resuscitation, Public, Automated external defibrillators Cost-effectiveness analysis, Public health, United States
Persistent URL dx.doi.org/10.1016/j.resuscitation.2019.03.029, hdl.handle.net/1765/117128
Journal Resuscitation
Citation
Andersen, L.W., Holmberg, M.J., Granfeldt, A., James, L.P, & Caulley, L. (2019). Cost-effectiveness of public automated external defibrillators. Resuscitation, 138, 250–258. doi:10.1016/j.resuscitation.2019.03.029