Authors' objectives: - To review the clinical evidence on the effectiveness and safety of public access defibrillation programmes for out-of-hospital cardiac arrest and identify the main factors associated with effective implementation of such programmes. - To review and summarise Irish data on the epidemiology of out-of-hospital cardiac arrest, the existing availability of automatic external defibrillators, and relevant initiatives in the management of sudden cardiac arrest and the configuration of emergency medical services. - To review the international cost-effectiveness literature on public access defibrillation. - To estimate the clinical benefits, cost-effectiveness, resource implications and budget impact of potential public access defibrillation programme configurations in Ireland. - To consider any wider implications that the technology may have for patients, the general public or the healthcare system. - Based on this assessment, to advise on the optimal configuration of an Irish public access defibrillation programme.

Authors' recommendations: Public access defibrillation has the potential to further improve survival from out-of-hospital cardiac arrest in Ireland. However, given the existing high rate of dispersal of AEDs in Ireland and the large numbers of the population already trained in CPR, coupled with uncertainty regarding where cardiac arrests will occur and low out-ofhospital cardiac arrest survival rates, a large number of additional AEDs are required in Ireland to increase the number of people who survive to hospital discharge. Public access defibrillation is expected to result in an average of between 2 and 10 additional out-of-hospital cardiac arrest patients surviving to discharge annually depending on which programme is implemented. Budget impact analysis indicates that the total incremental cost of implementing public access defibrillation over a five-year time horizon ranges from €1 million to €2.4 million for the health service, €2 million to €20 million for the public sector (including health) and €3.3 million to €85 million for the private sector, depending on which public access defibrillation programme is implemented. The majority of these costs would be incurred in the first year of the programme. The model of public access defibrillation outlined in the proposed legislation is associated with highest gains in survival and with the highest costs. Ireland already has a high level of diffusion of AEDs on a voluntary basis, however, this system is not standardised, coordinated or linked to emergency medical services. Based on current data, none of the public access defibrillation programmes evaluated would be considered cost-effective using conventional willingness to pay thresholds. However, significantly increased usage of AEDs as a result of a national EMS-linked AED register and increased public awareness could render public access defibrillation programmes more cost-effective. However there is no evidence to indicate how much of an increase could reasonably be expected. It is possible that a more cost-effective distribution of AEDs could be achieved using a deployment rule based on location-specific incidence rather than building type. Multiple years of data on the precise location of OHCA events would be required to identify such high-incidence locations. This data, and therefore any estimate of the cost-effectiveness of such a programme, is as yet unavailable. If a public access defibrillation programme is introduced in Ireland, it should be considered in conjunction with measures to increase the utilisation of publicly accessible AEDs, such as increased public awareness, expanded CPR and AED training and an EMS-linked AED register. Any prospective programme should start by targeting the mandatory deployment of AEDs to locations with the highest incidence of out-of-hospital cardiac arrest. A process of performance evaluation and research should be incorporated from the outset to guide ongoing tailoring of the programme to maximise efficiency.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.hiqa.ie/publications/health-technology-assessment-hta-public-access-defibrillation

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Ireland

Organisation Name: Health Information and Quality Authority (HIQA)

Contact Address: Health Information and Quality Authority, George's Court, George's Lane,Smithfield, Dublin 7. PH : + 353 (01) 814 7464

Contact Name: info@hiqa.ie

Contact Email: info@hiqa.ie

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