Cooling Treatment After Cardiac Arrest Found Cost-Effective

Therapeutic hypothermia, a brain-preserving cooling treatment, is a cost-effective way to improve outcomes after out-of-hospital cardiac arrest, claims a new study.

Researchers at the University of Pennsylvania (Penn, Philadelphia, USA) used a complex mathematical design to measure quality-adjusted survival after cardiac arrest, cost of hypothermia equipment and treatment, and cost of posthospital discharge care. Factors affecting costs included additional nursing care required during cooling treatment, extra time spent in the intensive care unit (ICU), and postdischarge care required. The model inputs were determined from published data, cooling device companies, and consultation with resuscitation experts. Sensitivity analyses and Monte Carlo simulations were performed to identify influential variables and uncertainty in cost-effectiveness estimates.

The researchers found that according to the model, post-cardiac-arrest patients receiving therapeutic hypothermia gained an average of 0.66 quality-adjusted life year (QALY) compared with conventional care, at an incremental cost of U.S. $31,254. This yielded an incremental cost-effectiveness ratio of $47,168 per QALY. Even at extreme estimates for costs, the cost-effectiveness of hypothermia remained less than $100,000 per QALY. Sensitivity analyses demonstrated that poor neurological outcome and costs associated with posthypothermia care (in-hospital and long term) were the most influential variables in the model. The study was published online ahead of print on August 4, 2009, in Circulation: Cardiovascular Quality and Outcomes.

"There are very few treatments for cardiac arrest victims, and hypothermia stands out as the only therapy which can improve neurologic survival,” said lead author emergency physician Raina Merchant, M.D., M.S. "Hospitals and physicians should promote rapid adoption of this treatment for patients, and cost should not be considered a barrier to use.”

"Having already established that hypothermia improves neurological outcomes after cardiac arrest, we now know that the therapy is also a good use of health care resources,” added Dr. Merchant. "We hope our findings will help more hospitals and insurers to adopt cooling protocols and help more survivors return to productive lives.”

U.S national recommendations that were established in 2005 called for out-of-hospital cardiac arrest patients to be treated with hypothermia when they remain comatose after resuscitation; despite this, many hospitals still fail to offer the intervention. Among the barriers to its use are concerns about its cost, and difficulty coordinating the interdisciplinary resources and staff needed to employ the treatment.

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