A cost effectiveness analysis compared the total costs and life expectancy of treating patients with a cardiac arrest with and without a defibrillator on site by location. Eighteen location types were considered: casinos, non-acute hospitals, shopping centres, nursing homes, penal institutions, hotels, golf courses, restaurants, airports/railway stations, marinas, schools, single stores, medical offices, office buildings, stadium, community facilities, factories, sports fields. Data on the incidence and age, sex and outcome of cardiac arrests by location was available for the province of Ontario for 1995 to 1999. A decision analysis model was created to estimate age and sex specific costs and life expectancies for individuals suffering cardiac arrests. Survival estimates and disease progression probabilities were derived from the Weinstein model and costs were based on observed health resource utilization of incident coronary heart disease for a representative sample of the Canadian population. The benefit of on site defibrillators was incorporated through data from a multicentre trial (RR of survival = 2). The Canadian costs of on-site defibrillators were included. Both future life expectancy and costs were discounted at a rate of 5%. Monte Carlo simulation estimated the uncertainty surrounding the estimated incremental cost effectiveness ratios.

For each of the 18 sites, the incremental cost effectiveness ratio associated with on-site availability of a defibrillator was calculated. There were two situations in which a defibrillator would be considered cost effective based on a willingness to pay threshold of $50,000 per life year gained, namely, casinos and non-acute hospitals. The ICER for casinos was $5811 per life year (p(<50,000)= 0.98) and it was $44786 (p(<50,000)=0.59) for non-acute hospitals. For only two other locations was the probability of being cost effective greater than 0.1%: nursing home (p<0.27), shopping mall (p<0.11).

This study demonstrates that it would be cost effective to install on-site defibrillators in both casinos and non-acute hospitals in Canada.