Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

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A Controlled Study of the Cost-Effectiveness of Emergency Medical Services for Out-of-hospital Cardiac Arrest: An Economic Evaluation of the OPALS Study

Academic Emergency Medicine ◽

10.1197/j.aem.2004.02.078 ◽

2004 ◽

Vol 11 (5) ◽

pp. 523-523

Author(s):

G. Nichol

Keyword(s):

Cardiac Arrest ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Emergency Medical Services ◽

Medical Services ◽

Controlled Study ◽

Emergency Medical ◽

The Cost ◽

Hospital Cardiac Arrest

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Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽

10.1542/peds.88.4.681 ◽

1991 ◽

Vol 88 (4) ◽

pp. 681-690 ◽

Cited By ~ 1

Author(s):

James S. Seidel ◽

Deborah Parkman Henderson ◽

Patrick Ward ◽

Barbara Wray Wayland ◽

Beverly Ness

Keyword(s):

Emergency Medical Services ◽

Rural Areas ◽

Urban Areas ◽

Pediatric Patients ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

Medical Services ◽

Care Providers ◽

Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

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Cost-effectiveness analysis of cinacalcet for haemodialysis patients with moderate-to-severe secondary hyperparathyroidism in China: evaluation based on the EVOLVE trial

BMJ Open ◽

10.1136/bmjopen-2019-034123 ◽

2020 ◽

Vol 10 (8) ◽

pp. e034123

Author(s):

Lin Liu ◽

Dongsheng Hong ◽

Kuifen Ma ◽

Bin Wu ◽

Xiaoyang Lu

Keyword(s):

Cost Effectiveness ◽

Willingness To Pay ◽

Secondary Hyperparathyroidism ◽

Treatment Effect ◽

Conventional Therapy ◽

Pharmacoeconomic Evaluation ◽

Sensitivity Analyses ◽

Secondary Outcome ◽

Life Years ◽

The Cost

ObjectiveAs the cost-effectiveness evaluation of cinacalcet and conventional therapy in China has not been reported, the objective of this study was to make a pharmacoeconomic evaluation of cinacalcet specific to the Chinese healthcare setting in patients with moderate-to-severe secondary hyperparathyroidism (SHPT) undergoing dialysis.DesignsData from Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events trial were used for this analysis. A semi-Markov model was constructed to estimate quality-adjusted life years (QALYs) and lifetime costs in cinacalcet plus conventional therapy (cinacalcet strategy) compared with conventional therapy (standard strategy), in patients with moderate-to-severe SHPT undergoing dialysis. Treatment effect estimates from the unadjusted intent-to-treat (ITT) analysis and covariate-adjusted ITT analysis were used as the main analyses. Model sensitivity to variations in individual inputs and overall decision uncertainty were assessed through probabilistic sensitivity analyses.Primary and secondary outcome measuresIncremental cost-effectiveness ratio (ICER) as measured by cost per QALY gained.ResultsThe ICER for cinacalcet strategy was US$44 400 per QALY gained using the covariate-adjusted ITT analysis. Probabilistic sensitivity analysis suggested a 46.2% chance of the ICER being below a willingness-to-pay threshold of US$26 508. Treatment effects from unadjusted ITT analysis yielded an ICER of US$87 210 per QALY. The model was most sensitive to the treatment effect on mortality.ConclusionsExisting evidence does not support the cost-effectiveness of cinacalcet strategy in patients with moderate-to-severe SHPT undergoing dialysis when applying a willingness-to-pay threshold of US$26 508 per QALY, whether it is using the treatment effect from covariate-adjusted ITT analysis or unadjusted ITT analysis.

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Standard Precautions Among Emergency Medical Services in Urban and Rural Areas

Workplace Health & Safety ◽

10.1177/2165079919864118 ◽

2019 ◽

Vol 68 (2) ◽

pp. 73-80

Author(s):

Riyadh A. Alhazmi ◽

R. David Parker ◽

Sijin Wen

Keyword(s):

West Virginia ◽

Emergency Medical Services ◽

Rural Areas ◽

Urban Areas ◽

Medical Services ◽

Cross Sectional Survey ◽

Standard Precautions ◽

Cross Sectional ◽

Emergency Medical ◽

Rural And Urban

Backround: Emergency medical services (EMS) workers are at risk of exposure to bloodborne pathogens and frequently exposed to blood and bodily fluids through percutaneous injuries. This study aimed to assess the consistency with which standard precautions (SPs) among rural and urban EMS providers were used. Methods: This study consisted of a cross-sectional survey conducted with a sample of certified EMS providers in West Virginia in which we ascertained details about sociodemographic characteristics, and the frequency of consistent SP. An email invitation was sent to a comprehensive list of agencies obtained from the Office of West Virginia EMS. Findings: A total of 248 out of 522 (47%) EMS providers completed the survey. The majority of the EMS providers (76%) consistently complied with SPs; however, more than one third (38%) of urban EMS providers indicated inconsistent use compared with 19% of rural EMS providers ( p = .002). Most EMS providers reported low prevention practices to exposure of blood and body fluids in both areas. Conclusion/Application to Practice: The results emphasize the need to enhanced safe work practices among EMS providers in both rural and urban areas through education and increasing self-awareness. Occupational health professional in municipalities that serve these workers are instrumental in ensuring these workers are trained and evaluated for their compliance with SPs while in the field.

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Correlation of age and rurality with low-urgency use of emergency medical services (LUEMS): A geographic analysis

CJEM ◽

10.1017/cem.2017.364 ◽

2017 ◽

Vol 20 (6) ◽

pp. 874-881 ◽

Cited By ~ 1

Author(s):

Mikiko Terashima ◽

Alix J.E. Carter

Keyword(s):

Emergency Medical Services ◽

Public Transportation ◽

Rural Areas ◽

Tertiary Care ◽

Incidence Rates ◽

Medical Services ◽

Older Population ◽

Age Cohorts ◽

Geographic Analysis ◽

Emergency Medical

ABSTRACTObjectivesStudies suggest that addressing the needs of the older population in rural areas may substantially reduce their low-urgency use of emergency medical services (LUEMS). It may ultimately also help improve the efficiency in our health system. There is, however, a dearth of evidence substantiating geographic patterns in LUEMS by different age cohorts. This exploratory study was aimed to clarify the understanding of emergency medical services (EMS) use in Nova Scotia through a geographic analysis.MethodsRecords with Canadian Triage and Acuity Scale of 4 and 5 were considered as LUEMS. We assessed the distribution of LUEMS incidence rates (proportion of LUEMS out of all EMS uses) by age and rurality, using descriptive statistics and Geographic Information Systems mapping.ResultsNearly half of all EMS transports were individuals of 65+ years of age; 35% of those were LUEMS. The rates increased along with the level of rurality, and the older cohort had the highest incidence rates in non-metro communities. High rates were seen primarily in some rural communities farthest away from the capital/tertiary care centre.ConclusionHigh LUEMS incidence rates are rural phenomena but not specific to the older population. However, the absolute number of LUEMS by the older cohort is significant, and elder-specific interventions in rural regions could still lead to effective cost savings. Further investigation of other factors, such as distance to the emergency department, availability of public transportation, and socioeconomic conditions of EMS users, is needed.

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