• Peter Cram, Sandeep Vijan, David Katz, and A Mark Fendrick.
• Division of General Medicine, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA, USA. peter-cram@uiowa.edu <peter-cram@uiowa.edu>
• J Gen Intern Med. 2005 Mar 1; 20 (3): 251258251-8.

Background/ObjectiveIn-home automated external defibrillators (AEDs) are increasingly recommended as a means for improving survival of cardiac arrests that occur at home. The current study was conducted to explore the relationship between individuals' risk of cardiac arrest and cost-effectiveness of in-home AED deployment.DesignMarkov decision model employing a societal perspective.PatientsFour hypothetical cohorts of American adults 60 years of age at progressively greater risk for sudden cardiac death (SCD): 1) all adults (annual probability of SCD 0.4%); 2) adults with multiple SCD risk factors (probability 2%); 3) adults with previous myocardial infarction (probability 4%); and 4) adults with ischemic cardiomyopathy unable to receive an implantable defibrillator (probability 6%).InterventionStrategy 1: individuals suffering an in-home cardiac arrest were treated with emergency medical services equipped with AEDs (EMS-D). Strategy 2: individuals suffering an in-home cardiac arrest received initial treatment with an in-home AED, followed by EMS.ResultsAssuming cardiac arrest survival rates of 15% with EMS-D and 30% with AEDs, the cost per quality-adjusted life-year gained (QALY) of providing in-home AEDs to all adults 60 years of age is 216,000 dollars. Costs of providing in-home AEDs to adults with multiple risk factors (2% probability of SCD), previous myocardial infarction (4% probability), and ischemic cardiomyopathy (6% probability) are 132,000 dollars, 104,000 dollars, and 88,000 dollars, respectively.ConclusionsThe cost-effectiveness of in-home AEDs is intimately linked to individuals' risk of SCD. However, providing in-home AEDs to all adults over age 60 appears relatively expensive.

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