Health system costs of out-of-hospital cardiac arrest in relation to time to shock
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 reduc...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2004-10, Vol.110 (14), p.1967-1973 |
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| container_end_page | 1973 |
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| container_issue | 14 |
| container_start_page | 1967 |
| container_title | Circulation (New York, N.Y.) |
| container_volume | 110 |
| creator | VAN ALEM, Anouk P DIJKGRAAF, Marcel G. W TIJSSEN, Jan G. P KOSTER, Rudolph W |
| description | 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.
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: < or =7 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 559 Euros, 6869 Euros and 666 Euros. Mean costs were 28,636 Euros per survivor and 2384 Euros per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20,253 Euros. Of the intermediate group (n=149), 26% survived, with costs averaging 31,467 Euros. Among patients shocked late (n=135), 13% survived, with costs averaging 27,781 Euros. 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 17,508 Euros, 14,303 Euros, and 12,708 Euros per life saved, respectively.
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. |
| doi_str_mv | 10.1161/01.cir.0000143150.13727.19 |
| format | Article |
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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: < or =7 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 559 Euros, 6869 Euros and 666 Euros. Mean costs were 28,636 Euros per survivor and 2384 Euros per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20,253 Euros. Of the intermediate group (n=149), 26% survived, with costs averaging 31,467 Euros. Among patients shocked late (n=135), 13% survived, with costs averaging 27,781 Euros. 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 17,508 Euros, 14,303 Euros, and 12,708 Euros per life saved, respectively.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.cir.0000143150.13727.19</identifier><identifier>PMID: 15381641</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Cohort Studies ; Coronary Care Units - economics ; Coronary Care Units - statistics & numerical data ; Cost-Benefit Analysis ; Defibrillators - economics ; Defibrillators - statistics & numerical data ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electric Countershock - statistics & numerical data ; Emergency Medical Services - economics ; Emergency Medical Services - methods ; Emergency Medical Services - statistics & numerical data ; Female ; Fundamental and applied biological sciences. Psychology ; Health Care Costs ; Health Resources - economics ; Health Resources - utilization ; Heart Arrest - economics ; Heart Arrest - etiology ; Heart Arrest - mortality ; Heart Arrest - nursing ; Heart Arrest - therapy ; Hospital Costs ; Humans ; Length of Stay - economics ; Life Tables ; Lymphatic system ; Male ; Medical sciences ; Middle Aged ; Netherlands ; Prospective Studies ; Survival Analysis ; Time Factors ; Ventricular Fibrillation - complications ; Ventricular Fibrillation - therapy ; Vertebrates: cardiovascular system</subject><ispartof>Circulation (New York, N.Y.), 2004-10, Vol.110 (14), p.1967-1973</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-daf8ae19a7b8a0be2a80f3903da4ae8292cedbd396f622ef4f1cc484c9cbd48f3</citedby><cites>FETCH-LOGICAL-c506t-daf8ae19a7b8a0be2a80f3903da4ae8292cedbd396f622ef4f1cc484c9cbd48f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16548767$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15381641$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>VAN ALEM, Anouk P</creatorcontrib><creatorcontrib>DIJKGRAAF, Marcel G. W</creatorcontrib><creatorcontrib>TIJSSEN, Jan G. P</creatorcontrib><creatorcontrib>KOSTER, Rudolph W</creatorcontrib><title>Health system costs of out-of-hospital cardiac arrest in relation to time to shock</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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: < or =7 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 559 Euros, 6869 Euros and 666 Euros. Mean costs were 28,636 Euros per survivor and 2384 Euros per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20,253 Euros. Of the intermediate group (n=149), 26% survived, with costs averaging 31,467 Euros. Among patients shocked late (n=135), 13% survived, with costs averaging 27,781 Euros. 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 17,508 Euros, 14,303 Euros, and 12,708 Euros per life saved, respectively.
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.</description><subject>Aged</subject><subject>Arterial hypertension. Arterial hypotension</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</subject><subject>Cohort Studies</subject><subject>Coronary Care Units - economics</subject><subject>Coronary Care Units - statistics & numerical data</subject><subject>Cost-Benefit Analysis</subject><subject>Defibrillators - economics</subject><subject>Defibrillators - statistics & numerical data</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electric Countershock - statistics & numerical data</subject><subject>Emergency Medical Services - economics</subject><subject>Emergency Medical Services - methods</subject><subject>Emergency Medical Services - statistics & numerical data</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Health Care Costs</subject><subject>Health Resources - economics</subject><subject>Health Resources - utilization</subject><subject>Heart Arrest - economics</subject><subject>Heart Arrest - etiology</subject><subject>Heart Arrest - mortality</subject><subject>Heart Arrest - nursing</subject><subject>Heart Arrest - therapy</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>Length of Stay - economics</subject><subject>Life Tables</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Ventricular Fibrillation - complications</subject><subject>Ventricular Fibrillation - therapy</subject><subject>Vertebrates: cardiovascular system</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFtLxDAQhYMoul7-ggRB37pmkjRtfJPFGwiC6HOYpgkbbTdrkn3w31t1YeflMMN3ZoZDyAWwOYCCawZzG9KcTQVSQD2NRcObOeg9MoOay0rWQu-T2QToqhGcH5HjnD-mVommPiRHUIsWlIQZeX10OJQlzd-5uJHamEum0dO4KVX01TLmdSg4UIupD2gppuRyoWFFkxuwhLiiJdISRvereRnt5yk58Dhkd7bVE_J-f_e2eKyeXx6eFrfPla2ZKlWPvkUHGpuuRdY5ji3zQjPRo0TXcs2t67teaOUV585LD9bKVlptu162XpyQq_-96xS_NtNXZgzZumHAlYubbJTSQkkOE3jzD9oUc07Om3UKI6ZvA8z8JmoYmMXTq9klav4SNaAn8_n2yqYbXb-zbiOcgMstgNni4BOubMg7TtWybVQjfgB984Cl</recordid><startdate>20041005</startdate><enddate>20041005</enddate><creator>VAN ALEM, Anouk P</creator><creator>DIJKGRAAF, Marcel G. W</creator><creator>TIJSSEN, Jan G. P</creator><creator>KOSTER, Rudolph W</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20041005</creationdate><title>Health system costs of out-of-hospital cardiac arrest in relation to time to shock</title><author>VAN ALEM, Anouk P ; DIJKGRAAF, Marcel G. W ; TIJSSEN, Jan G. P ; KOSTER, Rudolph W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-daf8ae19a7b8a0be2a80f3903da4ae8292cedbd396f622ef4f1cc484c9cbd48f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Arterial hypertension. Arterial hypotension</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Clinical manifestations. Epidemiology. Investigative techniques. Etiology</topic><topic>Cohort Studies</topic><topic>Coronary Care Units - economics</topic><topic>Coronary Care Units - statistics & numerical data</topic><topic>Cost-Benefit Analysis</topic><topic>Defibrillators - economics</topic><topic>Defibrillators - statistics & numerical data</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electric Countershock - statistics & numerical data</topic><topic>Emergency Medical Services - economics</topic><topic>Emergency Medical Services - methods</topic><topic>Emergency Medical Services - statistics & numerical data</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Health Care Costs</topic><topic>Health Resources - economics</topic><topic>Health Resources - utilization</topic><topic>Heart Arrest - economics</topic><topic>Heart Arrest - etiology</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - nursing</topic><topic>Heart Arrest - therapy</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>Length of Stay - economics</topic><topic>Life Tables</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Ventricular Fibrillation - complications</topic><topic>Ventricular Fibrillation - therapy</topic><topic>Vertebrates: cardiovascular system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>VAN ALEM, Anouk P</creatorcontrib><creatorcontrib>DIJKGRAAF, Marcel G. W</creatorcontrib><creatorcontrib>TIJSSEN, Jan G. P</creatorcontrib><creatorcontrib>KOSTER, Rudolph W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>VAN ALEM, Anouk P</au><au>DIJKGRAAF, Marcel G. W</au><au>TIJSSEN, Jan G. P</au><au>KOSTER, Rudolph W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Health system costs of out-of-hospital cardiac arrest in relation to time to shock</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2004-10-05</date><risdate>2004</risdate><volume>110</volume><issue>14</issue><spage>1967</spage><epage>1973</epage><pages>1967-1973</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>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.
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: < or =7 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 559 Euros, 6869 Euros and 666 Euros. Mean costs were 28,636 Euros per survivor and 2384 Euros per nonsurvivor. Among patients shocked early (n=24), 46% survived, with costs averaging 20,253 Euros. Of the intermediate group (n=149), 26% survived, with costs averaging 31,467 Euros. Among patients shocked late (n=135), 13% survived, with costs averaging 27,781 Euros. 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 17,508 Euros, 14,303 Euros, and 12,708 Euros per life saved, respectively.
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15381641</pmid><doi>10.1161/01.cir.0000143150.13727.19</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Arterial hypertension. Arterial hypotension Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Clinical manifestations. Epidemiology. Investigative techniques. Etiology Cohort Studies Coronary Care Units - economics Coronary Care Units - statistics & numerical data Cost-Benefit Analysis Defibrillators - economics Defibrillators - statistics & numerical data Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electric Countershock - statistics & numerical data Emergency Medical Services - economics Emergency Medical Services - methods Emergency Medical Services - statistics & numerical data Female Fundamental and applied biological sciences. Psychology Health Care Costs Health Resources - economics Health Resources - utilization Heart Arrest - economics Heart Arrest - etiology Heart Arrest - mortality Heart Arrest - nursing Heart Arrest - therapy Hospital Costs Humans Length of Stay - economics Life Tables Lymphatic system Male Medical sciences Middle Aged Netherlands Prospective Studies Survival Analysis Time Factors Ventricular Fibrillation - complications Ventricular Fibrillation - therapy Vertebrates: cardiovascular system |
| title | Health system costs of out-of-hospital cardiac arrest in relation to time to shock |
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