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Cost effectiveness analysis of out-of-hospital cardiac arrest management strategies

Feng, Haidong (2017) Cost effectiveness analysis of out-of-hospital cardiac arrest management strategies. Master Essay, University of Pittsburgh.

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Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is the sudden cessation of the heart in an out of hospital setting. In the United States, the incidence of OHCA is estimated at 110 individuals per 100,000 per year with an overall survival rate of 5.2%. The American Heart Association guidelines recommends angiography for patients who have ST elevation in electrocardiogram followed by proper treatments. In patients without ST elevation, other general tests and observations would be conducted before further interventions. Some evidence suggests that immediate angiography and appropriate intervention for OHCA patients could result in better healthcare outcomes regardless of the presence of ST elevation in electrocardiogram. The goal of this study is to investigate whether immediate angiography and PCI are cost-effective compared to the standard of care. Methods: We built a decision tree in TreeAge Pro Software to compare the cost-effectiveness of immediate angiography followed by proper interventions to standard care. The model calculates the costs and benefits of each strategy over a short-term period. We reviewed the literature to obtain the model parameters, including probabilities for choosing interventions, intervention costs, quality of life and life expectancy estimates. We calculated incremental cost-effectiveness ratio of immediate angiography strategy compared to standard of care. In addition, we tested the robustness of our outcomes using Tornado analysis, and probabilistic sensitivity analysis (PSA) in which we varied all the parameters jointly. Results: Immediate angiography was less expensive than the standard care ($1,281) per patient treated per year, and more effective [0.03 quality-adjusted life-years (QALYs)]. These findings were robust to all one-way sensitivity analyses. In addition, PSA showed there is more than 91% chance that immediate angiography is more cost effective than the standard care conditional on $100,000/QALY willingness to pay threshold. Conclusion: Our results suggest that immediate angiography is more cost effective than the standard care for OHCA patients from a societal perspective because the incremental cost-effectiveness ratio (ICER) is well below the threshold that is generally considered to be cost-effective by many health-care agencies. Cost-effectiveness analysis results from our group and others may help inform treatment strategy of OHCA patients and lead to improved allocation of healthcare resources for CVD treatment. Globally, public health resources are limited; the saved resources in the cardiovascular disease area could be used in other areas, like HIV/AIDS, purification water or poverty. From a public health point of view, the research we conducted can provide evidence and support for allocation of limited public health resources.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Feng, Haidonghaf41@pitt.eduHAF41
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBarinas-Mitchell, Emmaejb4@pitt.eduejb4UNSPECIFIED
Committee MemberJalal, Hawrehjalal@pitt.eduhjalalUNSPECIFIED
Committee MemberRoberts, Markmroberts@pitt.edumrobertsUNSPECIFIED
Date: April 2017
Date Type: Publication
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 14 Jul 2017 19:29
Last Modified: 02 Nov 2017 14:01
URI: http://d-scholarship.pitt.edu/id/eprint/31292

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