دورية أكاديمية
Cost-effectiveness analysis of a 'Termination of Resuscitation' protocol for the management of out-of-hospital cardiac arrest.
| العنوان: | Cost-effectiveness analysis of a 'Termination of Resuscitation' protocol for the management of out-of-hospital cardiac arrest. |
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| المؤلفون: | Nazeha N; Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore., Mao DR; Department of Acute and Emergency Care, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore., Hong D; Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore., Shahidah N; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore; Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore., Chua ISY; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore., Ng YY; Department of Preventive and Population Medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore 308207, Singapore., Leong BSH; Emergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore., Tiah L; Accident and Emergency, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore., Chia MYC; Emergency Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Singapore., Ng WM; Emergency Medicine Department, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore., Doctor NE; Department of Emergency Medicine, Sengkang General Hospital, 110 Sengkang E Wy, Singapore 544886, Singapore., Ong MEH; Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore., Graves N; Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore. Electronic address: n.graves@duke-nus.edu.sg. |
| المصدر: | Resuscitation [Resuscitation] 2024 Sep; Vol. 202, pp. 110323. Date of Electronic Publication: 2024 Jul 17. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier/north-Holland Biomedical Press Country of Publication: Ireland NLM ID: 0332173 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-1570 (Electronic) Linking ISSN: 03009572 NLM ISO Abbreviation: Resuscitation Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Limerick : Elsevier/north-Holland Biomedical Press Original Publication: London, Middlesex Pub. Co. |
| مواضيع طبية MeSH: | Out-of-Hospital Cardiac Arrest*/therapy , Out-of-Hospital Cardiac Arrest*/mortality , Out-of-Hospital Cardiac Arrest*/economics , Cost-Benefit Analysis* , Cardiopulmonary Resuscitation*/methods , Cardiopulmonary Resuscitation*/economics , Quality-Adjusted Life Years*, Humans ; Aged ; Male ; Female ; Singapore/epidemiology ; Emergency Medical Services/economics ; Emergency Medical Services/methods ; Markov Chains ; Withholding Treatment/economics ; Withholding Treatment/statistics & numerical data ; Clinical Protocols ; Middle Aged ; Aged, 80 and over ; Cost-Effectiveness Analysis |
| مستخلص: | Background: Historically in Singapore, all out-of-hospital cardiac arrests (OHCA) were transported to hospital for pronouncement of death. A 'Termination of Resuscitation' (TOR) protocol, implemented from 2019 onwards, enables emergency responders to pronounce death at-scene in Singapore. This study aims to evaluate the cost-effectiveness of the TOR protocol for OHCA management. Methods: Adopting a healthcare provider's perspective, a Markov model was developed to evaluate three competing options: No TOR, Observed TOR reflecting existing practice, and Full TOR if TOR is exercised fully. The model had a cycle duration of 30 days after the initial state of having a cardiac arrest, and was evaluated over a 10-year time horizon. Probabilistic sensitivity analysis was performed to account for uncertainties. The costs per quality adjusted life years (QALY) was calculated. Results: A total of 3,695 OHCA cases eligible for the TOR protocol were analysed; mean age of 73.0 ± 15.5 years. For every 10,000 hypothetical patients, Observed TOR and Full TOR had more deaths by approximately 19 and 31 patients, respectively, compared to No TOR. Full TOR had the least costs and QALYs at $19,633,369 (95% Uncertainty Interval (UI) 19,469,973 to 19,796,764) and 0 QALYs. If TOR is exercised for every eligible case, it could expect to save approximately $400,440 per QALY loss compared to No TOR, and $821,151 per QALY loss compared to Observed TOR. Conclusion: The application of the TOR protocol for the management of OHCA was found to be cost-effective within acceptable willingness-to-pay thresholds, providing some justification for sustainable adoption. Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024. Published by Elsevier B.V.) |
| فهرسة مساهمة: | Keywords: Cardiac arrest; Cost-effectiveness; Economic evaluation; Out-of-hospital cardiac arrest; Protocol; Termination of resuscitation |
| تواريخ الأحداث: | Date Created: 20240719 Date Completed: 20240911 Latest Revision: 20240911 |
| رمز التحديث: | 20240912 |
| DOI: | 10.1016/j.resuscitation.2024.110323 |
| PMID: | 39029582 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1873-1570 |
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| DOI: | 10.1016/j.resuscitation.2024.110323 |