Cost-effectiveness of airline defibrillators

Travellers on passenger airlines experiencing cardiac arrest almost always die due to delays in emergency medical care. That is, unless the airline has installed automated external defibrillators (AEDs) and trained personnel to use them. Voluntary deployment of AEDs on Quantas and American Airlines was found to save lives. And based on that experience, at the direction of the U.S. Congress the U.S. Federal Aviation Administration is requiring all commercial aircraft with at least one flight attendant to carry AEDs by 2004.

But the cost-effectiveness of the rule has not been proved. To examine the costs and effectiveness of several different options for AED deployment in the U.S. commercial air transportation system, researchers examined quality-adjusted survival after cardiac arrest, the costs of AED deployment on aircraft and of medical care for cardiac arrest survivors.

Researchers analysed various scenarios:

Adding AEDs on passenger aircraft with more than 200 passengers would cost $35,300 per quality-adjusted life-year (QALY) gained.

Additional AEDs on aircraft with capacities between 100 and 200 persons would cost an additional $40,800 per added QALY.

Full deployment on all passenger aircraft would cost an additional $94,700 per QALY gained compared with limited deployment on aircraft with capacity greater than 100.

Overall, they found the cost-effectiveness of placing AEDs on commercial aircraft compares favourably with the cost-effectiveness of widely accepted medical interventions and health policy regulations. For example, a recent study demonstrated that driver-side airbags have a cost-effectiveness of $30,000 per QALY compared with no airbags, and adding passenger-side airbags saves lives at a cost of $76,500 per QALY compared with driver-side airbags alone (values adjusted from published estimates to 2001 dollars).

Source: Peter W. Groeneveld et al., Cost-effectiveness of Automated External Defibrillators on Airlines, Journal of the American Medical Association, September 26, 2001.

For text (requires JAMA subscription) http://jama.ama-
assn.org/issues/v286n12/rfull/joc10628.html

For more on Airline Safety Regulations http://www.ncpa.org/pd/regulat/reg-1.html

FMF\3 October 2001