Cost-Effectiveness of a Community First Responder System for Out-of-Hospital Cardiac Arrest in Belgium

OBJECTIVES: Out-of-Hospital Cardiac Arrest (OHCA) is a major public health challenge across Europe, as evidenced by a survival rate to hospital discharge of only 8.5%. The implementation of a Community First Responder (CFR) system can significantly improve the survival rates and neurological outcomes, thereby improving public health and emergency response efficiency. This study evaluates the cost-effectiveness of a 2-step approach to implementing this system in Belgium.

METHODS: A decision tree and long-term Markov model were developed to estimate the cost-effectiveness. The model compared the costs and quality-adjusted life years of two scenarios with the current standard of care. Step 1 was an awareness campaign on OHCA. Step 2 was the implementation of a CFR system, including the integration of Automated External Defibrillators (AEDs) into a unified IT system, the integration with dispatch centers, and the recruitment and training of citizen responders. The analysis included survival to the emergency department, hospital, discharge, and neurologically intact survival. Sensitivity analyses explored parameter uncertainty and model robustness.

RESULTS: The awareness campaign and implementation of the FR system resulted in an incremental cost-effectiveness ratio (ICER) of €14,976 and €16,442 per quality-adjusted life year (QALY) gained for steps 1 and 2 respectively, both below the threshold of €35,000. The analyses demonstrated improvements in all stages, including survival to hospital discharge and neurologically intact survival. A probabilistic sensitivity analysis was conducted to assess the robustness of the results.

CONCLUSIONS: The enhancement of a CFR system in Belgium is a cost-effective strategy that improves survival after OHCA at an acceptable cost per QALY. The study emphasizes the importance of AED accessibility, CFRs, and streamlined emergency response to improve survival and quality of life for OHCA patients. These findings support the formulation of policy and the allocation of resources to strengthen emergency medical response to OHCA in Belgium.