• Nuraini Nazeha, Desmond Renhao Mao, Dehan Hong, Nur Shahidah, ChuaIvan Si YongISYDepartment of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore., Yih Yng Ng, LeongBenjamin S HBSHEmergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore., Ling Tiah, ChiaMichael Y CMYCEmergency Department, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore 308433, Singapore., Wei Ming Ng, Nausheen E Doctor, OngMarcus Eng HockMEHHealth Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore., and Nicholas Graves.
• Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
• Resuscitation. 2024 Jul 17; 202: 110323110323.

BackgroundHistorically in Singapore, all out-of-hospital cardiac arrests (OHCA) were transported to hospital for pronouncement of death. A 'Termination of Resuscitation' (TOR) protocol, implemented from 2019 onwards, enables emergency responders to pronounce death at-scene in Singapore. This study aims to evaluate the cost-effectiveness of the TOR protocol for OHCA management.MethodsAdopting a healthcare provider's perspective, a Markov model was developed to evaluate three competing options: No TOR, Observed TOR reflecting existing practice, and Full TOR if TOR is exercised fully. The model had a cycle duration of 30 days after the initial state of having a cardiac arrest, and was evaluated over a 10-year time horizon. Probabilistic sensitivity analysis was performed to account for uncertainties. The costs per quality adjusted life years (QALY) was calculated.ResultsA total of 3,695 OHCA cases eligible for the TOR protocol were analysed; mean age of 73.0 ± 15.5 years. For every 10,000 hypothetical patients, Observed TOR and Full TOR had more deaths by approximately 19 and 31 patients, respectively, compared to No TOR. Full TOR had the least costs and QALYs at $19,633,369 (95% Uncertainty Interval (UI) 19,469,973 to 19,796,764) and 0 QALYs. If TOR is exercised for every eligible case, it could expect to save approximately $400,440 per QALY loss compared to No TOR, and $821,151 per QALY loss compared to Observed TOR.ConclusionThe application of the TOR protocol for the management of OHCA was found to be cost-effective within acceptable willingness-to-pay thresholds, providing some justification for sustainable adoption.Copyright © 2024. Published by Elsevier B.V.

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