Economic evaluation of automated external defibrillator deployment in public settings for out-of-hospital cardiac arrest: a systematic review

ABSTRACT

Background

Out-of-hospital cardiac arrest (OHCA) is a major issue in aging populations. The use of automatic external defibrillators (AEDs) in public places improves cardiac arrest survival rates. The purpose of this study is to review economic evaluation studies of the use of AED technology in public settings for cardiac arrest resuscitation.

Methods

Our search covered 1990–2021 and included PubMed, Cochrane Library, Embase, Scopus, and Web of Science. We included studies that analyzed cost-effectiveness, cost-utility and cost-benefit of the AED technology. Also, we performed the quality assessment of the studies through the checklist of quality assessment standard of health economic studies (QHES).

Results

Our inclusion criteria were met by 25 studies. AEDs are found to be cost-effective in places with a high occurrence of cardiac arrest. In addition, proper integration of drones with AEDs into existing systems has the potential to significantly improve OHCA survival rates.

Conclusion

The present study found that putting AEDs in high-cardiac arrest and crowded areas reduces average costs. Despite this, the costs associated with acquiring and maintaining AEDs prevent their widespread use. Further research is needed to evaluate feasibility and explore innovative strategies for AED maintenance and accessibility.

KEYWORDS:

• Cost-effectiveness
• automatic external defibrillator
• out-of-hospital cardiac arrest
• cost-utility
• economic evaluation

Article highlights

• AEDs are cost-effective in settings with a high incidence of cardiac arrest, but not in locations with a lot of potential victims and resuscitators like golf courses and health clubs.

• Increasing AED availability and reducing response times significantly increase survival rates in cardiac arrest cases, emphasizing the importance of considering population density when determining AED distribution and placement.

• Adequate training and the integration of mobile technology, such as mobile phone apps, can greatly improve the utilization of AEDs and enhance outcomes in cardiac arrest cases.

• Since the majority of research was in the US, it is unclear if AEDs are cost-effective in low- and middle-income countries remains unknown.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Approvals

The study was approved by the National Committee of Ethics in Biomedical Research [IR.IUMS.REC.1399.1255].

Contributions

JA, AS, and AR were involved in the conception or design of the manuscript. AS and JA did the screening of the articles and AR acted as referee. VA, EA, ASA and MP did the analysis and interpretation of the data. AS, VA, AR, MP, SJA, and ASA drafted the manuscript. JA, VA, EA, AR, EA, SJA, EG, ASA and MP were involved in the critical revision of the manuscript and final approval of the manuscript. The authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2024.2354472

Additional information

Funding

This work was supported by the Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences [grant numbers 99-3-48-19442].