Cost-effectiveness of automated external defibrillators on airlines

Context Installation of automated external defibrillators (AEDs) on passeng er aircraft has been shown to improve survival of cardiac arrest in that se tting, but the cost-effectiveness of such measures has not been proven. Objective To examine the costs and effectiveness of several different optio ns for AED deployment in the US commercial air transportation system. Design, Setting, and Subjects Decision and cost-effectiveness analysis of a strategy of full deployment on all aircraft as well as several strategies of partial deployment only on larger aircraft, compared with a baseline str ategy of no AEDs on aircraft (but training flight attendants in basic life support) for a hypothetical cohort of persons experiencing cardiac arrest a board US commercial aircraft. Estimates for costs and outcomes were obtaine d from the medical literature, the Federal Aviation Administration, the Air Transport Association of America, a population-based cohort of Medicare pa tients, AED manufacturers, and the Bureau of Labor Statistics. Main Outcome Measures Quality-adjusted survival after cardiac arrest; costs of AED deployment on aircraft and of medical care for cardiac arrest survi vors. Results Adding AEDs on passenger aircraft with more than 200 passengers wou ld cost $35300 per quality-adjusted life-year (QALY) gained. Additional AED s on aircraft with capacities between 100 and 200 persons would cost an add itional $40800 per added QALY compared with deployment on large-capacity ai rcraft only, and full deployment on all passenger aircraft would cost an ad ditional $94700 per QALY gained compared with limited deployment on aircraf t with capacity greater than 100. Sensitivity analyses indicated that the q uality of life, annual mortality rate, and the effectiveness of AEDs in imp roving survival were the most influential factors in the model. In 85% of M onte Carlo simulations, AED placement on large-capacity aircraft produced c ost-effectiveness ratios of less than $50000 per QALY. Conclusion The cost-effectiveness of placing AEDs on commercial aircraft co mpares favorably with the cost-effectiveness of widely accepted medical int erventions and health policy regulations, but is critically dependent on th e passenger capacity of the aircraft. Placing AEDs on most US commercial ai rcraft would meet conventional standards of cost-effectiveness.