Estimates of Cost-Effectiveness of Prehospital Continuous Positive Airway Pressure in the Management of Acute Pulmonary Edema

Abstract

Objective. To estimate the cost-effectiveness of continuous positive airway pressure (CPAP) in managing prehospital acute pulmonary edema in an urban EMS system. Methods. Using estimates from published reports on prehospital andemergency department CPAP, a cost-effectiveness model of implementing CPAP in a typical urban EMS system was derived from the societal perspective as well as the perspective of the implementing EMS system. To assess the robustness of the model, a series of univariate andmultivariate sensitivity analyses was performed on the input variables. Results. The cost of consumables, equipment, andtraining yielded a total cost of $89 per CPAP application. The theoretical system would be expected to use CPAP 4 times per 1000 EMS patients andis expected to save 0.75 additional lives per 1000 EMS patients at a cost of $490 per life saved. CPAP is also expected to result in approximately one less intubation per 6 CPAP applications andreduce hospitalization costs by $4075 per year for each CPAP application. Through sensitivity analyses the model was verified to be robust across a wide range of input variable assumptions. Conclusion. Previous studies have demonstrated the clinical effectiveness of CPAP in the management of acute pulmonary edema. Through a theoretical analysis which modeled the costs andclinical benefits of implementing CPAP in an urban EMS system, prehospital CPAP appears to be a cost-effective treatment.

Key words:

• EMS
• emergency medical services
• paramedic
• continuous positive airway pressure
• pulmonary edema
• cost-effectiveness