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currently considered state-of-the-art care for
patients with OHCA. Using the THA Bundle
of Care model, we estimated the cost associated with prehospital care and in-hospital
care based on the costs associated with each
of the key medical interventions.
This kind of care is currently provided in
multiple EMS systems throughout the U.S.,
from Anchorage, Alaska; Whatcom County,
Wash.; Salt Lake City; to Palm Beach County,
Fla. When fully implemented, this approach
can result in a nearly 20% overall survival rate
with good neurologic function.
Current literature tells us that the direct
costs of care for patients who survive to hospital discharge is $37,000. For patients who
die prior to hospital discharge, the cost of care
is estimated at $9,000 per patient. 1
There’s also a direct margin (i.e., profit) of
$21,000 associated with each OHCA patient
who survives to hospital discharge with good
brain function, and $3,300 for each patient
who doesn’t survive to hospital discharge.
With these data, we can now estimate the
direct cost of prehospital care for the roughly
350,000 annual OHCA patients in the U.S.
In some smaller cities and rural areas, the
costs may be higher, and vice versa for larger
Nonetheless, these calculations provide a
reasonable estimate of the true costs. We can
use these data to get the resources we need to
take care of our patients.
We estimated the direct costs associated
with the care of patients with OHCA based
upon the experience in Minneapolis, where all
elements of the THA Bundle have been fully
implemented. With a population of 400,000,
Minneapolis residents experience approximately 400 cardiac arrests each year.
We assume that all first responder firefighters and ALS ambulances in Minneapolis
carry advanced defibrillators, automated CPR
devices, manual active compression decompression (ACD) CPR devices, impedance
threshold devices (ITD), intraosseous (IO)
drug delivery systems, and CPR feedback
tools. (See Table 1 for the estimated cost of
this equipment, which we assume has a minimum of a three-year shelf life before it needs
to be replaced.)
Based on the annual cost of this equipment
ammortized over a three-year period, and the
total budget for the CPR technologies needed
to serve a population of 400,000 people with
40 BLS and ALS rigs, we calculated a cost of
approximately $1,063 for each patient treated
outside the hospital, regardless of outcome.
With 400 OHCA patients, the direct cost
for equipment in this scenario is estimated
at $425,200—or $10,630 per rig, per year.
The direct cost for OHCA prehospital
care is $1,063 per patient, per year. In Minneapolis, about 40% of all OHCA patients
are resuscitated and admitted to the hospital,
and the overall rate of patients who survive
to hospital discharge with good neurological
function is approximately 15%.
Based on the calculations in Tables 2 and 3
(See p. 14), we can determine that the direct
costs for prehospital and in-hospital care for an
OHCA is $12,945, regardless of outcome. The
cost for a survivor with good brain function is
$38,063 (i.e., the sum of the prehospital and in-hospital care costs).
If we spread out the direct cost for each
OHCA patient treated ($12,945) across the
approximately 120 million taxpayer families
in the U.S., the direct costs for each survivor,
regardless of the outcome, is $38 per year.
(See Table 4, p. 14.)
If we do the same with the costs of $38,063
for each OHCA patient discharged with good
brain function, the direct costs to individual
taxpayers is $17 per year for each OHCA
survivor. (See Table 3, p. 14.)
These costs include all of the latest state-of-the-art prehospital and in-hospital care,
including all the interventions shown in Figure 1. Relative to the costs of other disease
states, these direct costs are very manageable.
(See Table 5, p. 16.)
Table 1: Annual cost of prehospital
equipment per vehicle used to
treat OHCA (over three years)
Automated CPR device $13,000
ACD+ITD devices $1,000
Intra-osseous (IO) device $400
over 3 years)
(annual cost) $1,500