PDF(Pubmed)
Abstract：
UNASSIGNED: Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources.
UNASSIGNED: To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings.
UNASSIGNED: The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints.
UNASSIGNED: 468 unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in TOR protocols, professional prehospital defibrillator use, and CPR training followed by distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment.
UNASSIGNED: Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.
UNASSIGNED: To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings.
UNASSIGNED: The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints.
UNASSIGNED: 468 unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in TOR protocols, professional prehospital defibrillator use, and CPR training followed by distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment.
UNASSIGNED: Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.
摘要：
背景：院外心脏骤停（OHCA）是一种普遍存在的疾病，即使在有大量急诊护理资源的情况下，死亡率也很高，预后也很差。针对OHCA的干预措施取得的成功有限，在高收入国家的国家样本中，存活率低于10%。在资源有限的设置中，稀缺性需要仔细设定优先级，需要更多的数据来确定资源的最佳分配。目的建立OHCA护理的成本效益，并评估跨收入环境的干预措施的可负担性。方法作者对解决OHCA的干预措施进行了系统评价。包括的研究是（1）经济评估（除了简单的成本计算之外）；（2）评估了OHCA生存链中的干预措施。使用CHEERs清单和数据汇总评估文章质量。审查人员确定的主要主题报告了调查结果。根据成本效益分析的结果，我们然后从面临资源限制的决策者的角度对OHCA生存链的逐步实现进行分析。结果筛选出468篇独特文章，并包括46篇文章用于最终数据抽象。研究主要使用医疗保健部门的观点，为所有经历非创伤性心脏OHCA的患者建模，总部设在美国，并以美元显示结果。没有研究报告结果或使用来自低收入环境的模型输入。生存链的逐步实现可能始于对TOR协议的投资，专业院前除颤器使用，和CPR培训，然后在高密度公共场所分配AED。最后,其他干预措施，如随意放置除颤器或使用肾上腺素，将是早期投资的最低优先事项。结论我们的综述没有发现在低资源环境中治疗OHCA的成本效益的高质量证据。可以利用现有证据来制定制定OHCA护理成本效益高的方法的路线图，然而,在这些情况下,使用特定背景数据进行进一步的经济评估对于准确告知急诊护理中稀缺资源的优先次序至关重要.
