Abstract 596: Therapeutic Hypothermia After Cardiac Arrest: A Cost-Effectiveness Analysis

Abstract

Background: Mild induced therapeutic hypothermia (TH) is currently recommended for survivors of out-of-hospital cardiac arrest (OHCA) who meet specified criteria. If TH were fully implemented in the US, 2298 additional OHCA victims every year could be expected to survive. Despite a 2006 meta-analysis clearly demonstrating a decrease in mortality and an improvement in neurological outcome (with no treatment-limiting side effects) for TH, clinicians have been reluctant to adopt the therapy, often citing cost as a reason. The aim of this study was to determine the cost-effectiveness (CE) of TH after OHCA relative to supportive care. Methods: Monte Carlo simulation was used to approximate the cost per in-hospital death prevented, the cost per poor neurological outcome averted, and annual hospital costs. Estimates of effectiveness and resource use were extracted from secondary data sources. Included variables were: in-hospital mortality, neurological status, ICU and hospital ward length-of-stay (LOS), ICU and hospital ward cost/day, equipment costs, physician time, and medications. For our base case, we calculated the CE of treating 60 patients/year using a moderate cost method. We did sensitivity analyses through systematic bidirectional adjustments of selected variables’ costs, by reducing the treated patients/year to 12, and by excluding the cost of medications and physician time. All analyses were done from a US hospital perspective and reported in 2008 US$. Results: LOS dominated the difference in cost. The median cost per death prevented was $280,092 [IQR $202,279-$386,215] and per poor neurological outcome averted it was $147,314 [IQR $118,009-$182,251]. The median annual cost to treat 60 patients/year using a moderate cost method was $1,588,730 [IQR $1,322,343-$1,865,462]. Reducing the number of patients treated per year to 12 lowered the annual cost to $319,759 [IQR $268,122-$373,670]. The results of all other sensitivity analyses were similar to the base case. Assuming a mean duration of survival following hospital discharge of 6.13 years, TH had a cost/life-year saved of $45,692, which compares favorably to other life-saving health and social interventions. Conclusion: TH after OHCA is a relatively cost-effective treatment modality.