Cost‐effectiveness analysis of an ambulance service‐operated specialised cardiac vehicle with mobile extracorporeal cardiopulmonary resuscitation capacity for out‐of‐hospital cardiac arrests in Queensland, Australia

• Published in: Emergency medicine Australasia 2024-10, Vol.36 (5), p.751-758
• Main Authors: Doan, Tan N, Rashford, Stephen, Bosley, Emma
• Format: Article
• Language: English
• Subjects: Ambulances - economics; Cardiopulmonary Resuscitation - economics; Cardiopulmonary Resuscitation - methods; Cost-Benefit Analysis; Cost-Effectiveness Analysis; cost‐effectiveness; Emergency Medical Services - economics; Emergency Medical Services - methods; extracorporeal cardiopulmonary resuscitation; Humans; mobile extracorporeal membrane oxygenation device; Out-of-Hospital Cardiac Arrest - economics; Out-of-Hospital Cardiac Arrest - therapy; out‐of‐hospital cardiac arrest; Queensland
• ISSN: 1742-6731; 1742-6723; 1742-6723
• DOI: 10.1111/1742-6723.14447

Objective Extracorporeal CPR (E‐CPR) has been primarily limited to the in‐hospital setting. A few systems around the world have implemented pre‐hospital mobile E‐CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians required for the performance of E‐CPR on‐scene. However, evidence of the outcomes and cost‐effectiveness of mobile E‐CPR remain to be established. We evaluated the cost‐effectiveness of a hypothetical mobile E‐CPR vehicle operated by Queensland Ambulance Service in the state of Queensland, Australia. Methods We adapted our published mathematical model to estimate the cost‐effectiveness of pre‐hospital mobile E‐CPR relative to current practice. In the model, a specialised cardiac vehicle with mobile E‐CPR capability is deployed to selected OHCA patients, with eligible candidates receiving pre‐hospital E‐CPR in‐field and rapid transport to the closest appropriate centre for in‐hospital E‐CPR. For comparison, non‐candidates receive standard ACLS from a conventional ambulance response. Cost‐effectiveness was expressed as Australian dollars ($, 2021 value) per quality‐adjusted life year (QALY) gained. Results Pre‐hospital mobile E‐CPR improves outcomes compared to current practice at a cost of $27 323 per QALY gained. The cost‐effectiveness of pre‐hospital mobile E‐CPR is sensitive to the assumption around the number of patients who are the targets of the vehicle, with higher patient volume resulting in improved cost‐effectiveness. Conclusions Pre‐hospital E‐CPR may be cost‐effective. Successful implementation of a pre‐hospital E‐CPR programme requires substantial planning, training, logistics and operational adjustments.