Health system costs of out-of-hospital cardiac arrest in relation to time to shock

Background - Early defibrillation results in higher admission rates and healthcare costs. This study determined the healthcare resources used and related medical costs after out-of-hospital cardiac arrest (OHCA) in relation to time to shock. We assessed the incremental healthcare costs per life gained from reduction in time to shock of 2, 4, and 6 minutes. Methods and Results - Clinical and costs data of patients in witnessed OHCA with ventricular fibrillation as initial rhythm were collected. Each patient's time to shock was estimated and assigned to 1 of 3 categories: less than or equal to7 minutes ( early), 7 to 12 minutes ( intermediate), and >12 minutes ( late). Incremental cost-effectiveness analysis and Monte Carlo simulation compared scenarios of reduction in time to shock of 2, 4, and 6 minutes. Six-month survival was 22%. Mean prehospital, in-hospital, and posthospital costs in the first half-year after OHCA were E559, E6869 and E666. Mean costs were E28 636 per survivor and E2384 per nonsurvivor. Among patients shocked early (n = 24), 46% survived, with costs averaging E20 253. Of the intermediate group ( n = 149), 26% survived, with costs averaging E31 467. Among patients shocked late ( n = 135), 13% survived, with costs averaging E27 781. The point estimates of the incremental cost-effectiveness ratios of reduction of time to shock of 2, 4, and 6 minutes compared with baseline were E17 508, E14 303, and E12 708 per life saved, respectively. Conclusions - Costs per survivor were lowest with the shortest time to shock because of shorter stay in the intensive care unit. Reducing the time to defibrillation increases the healthcare costs by an acceptable amount according to current standards and is economically attractive