Abstract：
OBJECTIVE: To compare the cost-effectiveness of termination-of-resuscitation (TOR) rules for patients transported in cardiac arrest.
METHODS: The economic analyses evaluated cost-effectiveness of alternative TOR rules for OHCA from a National Health Service (NHS) and personal social services (PSS) perspective over a lifetime horizon. A systematic review was used to identify the different TOR rules included in the analyses. Data from the OHCAO outcomes registry, trial data and published literature were used to compare outcomes for the different rules identified. The economic analyses estimated discounted NHS and PSS costs and quality-adjusted life-years (QALYs) for each TOR rule, based on which incremental cost-effectiveness ratios (ICERs) were calculated.
RESULTS: The systematic review identified 33 TOR rules and the economic analyses assessed the performance of 29 of these TOR rules plus current practice. The most cost-effective strategies were the European Resuscitation Council (ERC) termination of resuscitation rule (ICER of £8,111), the Korean Cardiac Arrest Research Consortium 2 (KOC 2) termination of resuscitation rule (ICER of £17,548), and the universal Basic Life Support (BLS) termination of resuscitation rule (ICER of £19,498,216). The KOC 2 TOR rule was cost-effective at the established cost-effectiveness threshold of £20,000-£30,000 per QALY.
CONCLUSIONS: The KOC 2 rule is the most cost-effective at established cost-effectiveness thresholds used to inform health care decision-making in the UK. Further research on economic implications of TOR rules is warranted to support constructive discussion on implementing TOR rules.
METHODS: The economic analyses evaluated cost-effectiveness of alternative TOR rules for OHCA from a National Health Service (NHS) and personal social services (PSS) perspective over a lifetime horizon. A systematic review was used to identify the different TOR rules included in the analyses. Data from the OHCAO outcomes registry, trial data and published literature were used to compare outcomes for the different rules identified. The economic analyses estimated discounted NHS and PSS costs and quality-adjusted life-years (QALYs) for each TOR rule, based on which incremental cost-effectiveness ratios (ICERs) were calculated.
RESULTS: The systematic review identified 33 TOR rules and the economic analyses assessed the performance of 29 of these TOR rules plus current practice. The most cost-effective strategies were the European Resuscitation Council (ERC) termination of resuscitation rule (ICER of £8,111), the Korean Cardiac Arrest Research Consortium 2 (KOC 2) termination of resuscitation rule (ICER of £17,548), and the universal Basic Life Support (BLS) termination of resuscitation rule (ICER of £19,498,216). The KOC 2 TOR rule was cost-effective at the established cost-effectiveness threshold of £20,000-£30,000 per QALY.
CONCLUSIONS: The KOC 2 rule is the most cost-effective at established cost-effectiveness thresholds used to inform health care decision-making in the UK. Further research on economic implications of TOR rules is warranted to support constructive discussion on implementing TOR rules.
摘要：
目的：比较心脏骤停患者复苏终止（TOR）规则的成本-效果。
方法：经济分析从国家卫生服务（NHS）和个人社会服务（PSS）的角度评估了OHCA替代TOR规则的成本效益。系统评价用于确定分析中包含的不同TOR规则。来自OHCAO结果注册表的数据，试验数据和已发表的文献用于比较所确定的不同规则的结局.经济分析估计了每个TOR规则的贴现NHS和PSS成本以及质量调整寿命年(QALY)，在此基础上计算增量成本效益比(ICER)。
结果：系统审查确定了33条TOR规则，经济分析评估了其中29条TOR规则的性能以及当前的实践。最具成本效益的策略是欧洲复苏委员会（ERC）终止复苏规则（ICER为8,111英镑），韩国心脏骤停研究集团2（KOC2）终止复苏规则（ICER£17,548），和普遍的基本生命支持（BLS）终止复苏规则（ICER£19,498,216）。KOC2TOR规则在既定的每QALY20,000-30,000英镑的成本效益阈值下具有成本效益。
结论：KOC2规则在既定的成本效益阈值下是最具成本效益的，用于为英国的医疗保健决策提供信息。有必要对TOR规则的经济含义进行进一步研究，以支持有关实施TOR规则的建设性讨论。
方法：经济分析从国家卫生服务（NHS）和个人社会服务（PSS）的角度评估了OHCA替代TOR规则的成本效益。系统评价用于确定分析中包含的不同TOR规则。来自OHCAO结果注册表的数据，试验数据和已发表的文献用于比较所确定的不同规则的结局.经济分析估计了每个TOR规则的贴现NHS和PSS成本以及质量调整寿命年(QALY)，在此基础上计算增量成本效益比(ICER)。
结果：系统审查确定了33条TOR规则，经济分析评估了其中29条TOR规则的性能以及当前的实践。最具成本效益的策略是欧洲复苏委员会（ERC）终止复苏规则（ICER为8,111英镑），韩国心脏骤停研究集团2（KOC2）终止复苏规则（ICER£17,548），和普遍的基本生命支持（BLS）终止复苏规则（ICER£19,498,216）。KOC2TOR规则在既定的每QALY20,000-30,000英镑的成本效益阈值下具有成本效益。
结论：KOC2规则在既定的成本效益阈值下是最具成本效益的，用于为英国的医疗保健决策提供信息。有必要对TOR规则的经济含义进行进一步研究，以支持有关实施TOR规则的建设性讨论。
