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Dr. Lars W. Andersen

Evaluating the cost-effectiveness of AEDs in the U.S.

From the May 2019 issue of DOTmed HealthCare Business News magazine
It’s well known that public automated external defibrillators (AEDs) lead to better outcomes for cardiac arrest, but researchers based in Denmark set out to answer a more difficult question: are they actually cost effective?

By estimating costs in U.S. dollars per year of life adjusted for quality, the researchers looked at U.S. data on out-of-hospital cardiac arrest and determined public AED placement was indeed cost-effective and increased years of quality living. The findings were published in the May issue of the journal, Resuscitation.

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HealthCare Business News spoke to one of the researchers, Lars Wiuff Andersen, M.D., M.P.H., Ph.D., D.M.Sc., from the Research Center for Emergency Medicine in Arhus, Denmark to learn more about the methods used in the study and what their findings should mean for AED access and utilization going forward.

HCB News: What prompted you to examine the cost-effectiveness of public AEDs?
Dr. Lars W. Andersen: There have been great a number of studies examining the association between the use of an AED and outcomes. We know from those studies that the use of an AED is associated with improved outcomes in patients who have a shockable rhythm (i.e., ventricular fibrillation or pulseless ventricular tachycardia).

Despite this, AEDs are still rarely used. One of the reasons for this low use might be a perception that AEDs are not cost-effective. Although there have been previous cost-effectiveness analyses, these have generally been conducted more than 10 years ago and did not account for a number of potentially relevant factors. Personally, I was also uncertain about the cost-effectiveness given the relative rarity of cardiac arrest at a given location. I therefore thought it would be interesting to examine this in a comprehensive analysis.

HCB News: AEDs are only used in about 10 percent of out of hospital cardiac arrests, what can we attribute that low number to?
LWA: There are basically two issues: 1) AEDs are not available and 2) AEDs that are available are not used. The first problem can only be addressed by putting up more AEDs in locations that are available to the public (i.e., available and unlocked 24/7). Who should put up these AEDs? That is a policy decision that is beyond my expertise. The second problem should be, and is being, addressed by education. One of the cool things that has happened in many countries (including Denmark, where I am from) is the introduction of CPR and AED training in primary school and as part of taking a driver’s license. This should ensure that as many as possible are being trained. This will make people more comfortable using an AED when a cardiac arrest occurs.
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