The value of mechanical cardiopulmonary resuscitation using LUCAS

Sammanfattning: Introduction Economic evaluations are used in health care to help decision-makers allocate their resources. The objective of this study is to evaluate the cost-effectiveness of mechanical chest compressions compared to manual chest compressions. This is done in a Swedish setting and for out- of-hospital cardiac arrests (OHCA) using results from a large randomized controlled trial, the LINC study. Methods Mechanical CPR has been seen to improve neurological outcomes determined by the Cerebral Performance Category, and these results are used in a cost estimation to evaluate the effectiveness of treatment. This study argues costs and effects as far as possible to give meaning to this measurement despite its limitations. The analysis is made with a Swedish decision-makers purchasers’ perspective, as the societal perspective is considered in the discussion. A representative example was used to find the results and describes a case where 154 out-of-hospital cardiac arrest patients are annual possible treatments for 12 mechanical devices. Costs are calculated for the number of mechanical devices needed to deal with these patients along with treatment costs and additional hospital stay costs for mechanical treated patients. Effects of treatment are taken from the LINC study and a study by Phelps, Dumas, Maynard, Silver, & Rea (2013) and were translated into quality-adjusted life years (QALY). This is done with a focus group (clinical active medical doctors and nurses) that together answer a standardized instrument, EQ-5D, and in this way the paper obtain QALY-weights for each CPC-score. Results The cost-effectiveness of mechanical CPR is presented from a short-term perspective (patients’ gains in QALY during the first 6 months) as well as a longer-term perspective (patients’ gain in QALY over 8 years). As time prolongs the incremental cost-effectiveness ratio results show that costs per QALY gained range from “high” 508,291 SEK (6 months) to ”low” 50,508 SEK (8 years). Mechanical CPR shows to save 0.046 QALYs per OHCA patient over an 8-year period. The sensitivity analyses indicate that results do vary a lot with yearly number of treatments expected per device and the applied timeframe for effect calculation. Conclusion The paper believes to have given a transparent overview of a representative example facing decision-makers in this area. Giving them with the possibility to look at the value of mechanical CPR in a longer timeframe and not just in the short run with survival as only outcome. It concludes that if decision-makers are willing to live with the uncertainties discussed and argued in this paper, then mechanical devices are available at low costs per QALY gained for the patients treated. This is when each device is expected to deal with 12.83 yearly out-of-hospital cardiac arrests cases.