2026-10-07T21:44:32Z https://api.figshare.com/v2/oai

oai:figshare.com:article/34025332 2026-09-29T17:13:58Z category_7 category_45 category_734 category_106 portal_87 item_type_6 month_year_09_2026

The cost-effectiveness and health equity of prehospital treatment strategies for out-of-hospital cardiac arrest patients: a systematic review Kyumin Jang (25138135) Rachael L. Morton (3091632) Mark Dennis (15454055) Jessica Nikolovski (25138138) Xin Zhan (169128) Yuling Ke (25138141) Brian Burns (5475353) Anh D Tran (25138144) Medicine Sociology Biological Sciences not elsewhere classified Science Policy Ambulances Emergency Medical Services Out-of-Hospital Cardiac Arrest Health equity Cost-Effectiveness Analysis Health Economic Evaluation <p>Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge, associated with substantial mortality and significant costs for health care system. This systematic review aimed to (i) synthesise economic evaluations of prehospital treatment strategies for OHCA from ambulance attendance through to hospital discharge; (ii) assess the methodological quality and reporting of the included studies; and (iii) evaluate the reporting of health equity-relevant data.</p> <p>We searched Medline, Embase, Scopus, EconLit, and CINAHL databases for records from database inception to 12 June 2026. The QHES and CHEERS checklists were used to assess the quality and reporting standards of included studies, and the review was reported according to the PRISMA checklist. The completeness of reporting health equity outcomes was reviewed using the PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status and Social capital) - Plus framework.</p> <p>Ten economic evaluations met eligibility criteria. Most studies were cost-utility analyses (n = 8, 80%) and used Markov models (n = 6, 60%). Most evaluations were ‘very good quality’ ( ≥80%) (n = 6, 60%). Early defibrillation and advanced life support (ALS) delivered by trained emergency medical technicians were cost-effective compared with no intervention, emergency physician-led ALS, standard emergency medical services or paramedic care (ICER range from £11,407 to USD $56,700 per QALY gained). Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) was more cost-effective than in-hospital ECPR strategies (ICER range from AUD $27,323 to $44,000 per QALY gained). Termination-of-resuscitation (TOR) strategies were cost-effective compared with no TOR or other TOR strategies, including basic life support and ALS TOR, with estimates of $110,554 saved per QALY lost and USD $23,851 per QALY gained.</p> <p>Survival rate and neurological outcomes influenced cost-effectiveness results. Equity reporting was limited: almost all included studies addressed less than 40% of the PROGRESS-Plus equity criteria.</p> <p>Most strategies that increased prehospital treatment intensity, avoided futile transport, or enabled earlier advanced care were cost-effective; however, the certainty of evidence, particularly for sub-groups, was limited by heterogeneous comparators and sparse equity reporting.</p> 2026-09-29T17:13:58Z Text Journal contribution 10.6084/m9.figshare.34025332.v1 https://figshare.com/articles/journal_contribution/The_cost-effectiveness_and_health_equity_of_prehospital_treatment_strategies_for_out-of-hospital_cardiac_arrest_patients_a_systematic_review/34025332 CC BY 4.0