Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium
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2020) 18:52
Cost Effectiveness and Resource Allocation Open Access
RESEARCH
Cost‑effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium Steven Vercammen1* and Esther Moens2
Abstract Background: EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. Methods: An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. Results: Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1. Conclusions: EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation. Keywords: OHCA, Public AED, Cost-effectiveness, Mobile phone application JEL: I18, Government Policy, Regulation, Public Health Background Out-of-hospital cardiac arrest (OHCA) is a major health problem, with Belgian incidence rates of emergency medical services (EMS) attending OHCA of cardiac origin of approximately 82.8 per 100 000 person-years (86.4 on average in Europe) [1–3]. Important determinants of survival after OHCA are early cardiopulmonary resuscitation (CPR) as part of basic life support (BLS) and rapid defibrillation to restore spontaneous circulation [4, 5]. Delayed arrival time of the EMS has been associated with *Correspondence: [email protected] 1 EVapp vzw, AA Tower – 8th floor, Technologiepark 122 (zone C2a), 9052 Zwijnaarde, België Full list of author information is available at the end of the article
poor survival [6, 7]. Publicly available automated external defibrillators (AED) permit bystanders of OHCA or first responders, not trained in advanced life support (ALS), to provide early defibrillation prior to EMS arrival. A recent meta-analysis concluded that bystander AED use was associated with increased survival to hospital discharge (all rhythms OR: 1.73, shockable rhythms OR: 1.66) and favourable neurological outcome (all rhythms OR: 2.12, shockable rhythms OR: 2.37) [8]. In recent studies, high survival rates of 30–70% have been reported for OHCA patients defibrillated with a publicly accessible AED, early after collapse [9–14]. No ass
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