The Costs of a Suburban Paramedic Program in Reducing Deaths due to Cardiac Arrest.

Urban N, Bergner L, Eisenberg MS Medical Care 1981 Vol 19 Pages 379-392

The authors calculate costs per averted death from cardiac arrest due to underlying heart disease within a suburban paramedic program. The county reviewed has a population density of approximately 1,300/sq. mi., a basic EMS system with a 4-minute average response time, a citizen CPR training program, and an 10-minute average time to definitive advanced life support by paramedics. A total of 1,035 pre-hospital cardiac arrests were followed until death or discharge. A comparison was made between 17 months before paramedics were introduced, and 19 months with paramedic services. A significantly higher proportion of cardiac arrest patients were admitted and subsequently discharged from hospital when paramedics serviced the area. The authors suggest that with 95% confidence, for every 100 arrests, the paramedic program can be expected to result in between 11.6 and 23.8 more admissions and between 8.9 and 18.3 fewer deaths as well as between 7.8 and 36.4 fewer in-hospital deaths. That is, approximately 13.6 cardiac arrest deaths/100 cardiac arrests can be averted by the paramedic program that would not have been averted by the basic life support system. The marginal costs per averted death are estimated at approximately 42,000 1978 dollars, when program costs are attributed entirely to cases of cardiac arrest due to underlying heart disease (i.e., the entire cost of the paramedic system is applied to cardiac arrest patients only), and indirect costs attributable to these hospitalizations are included. When other benefits of paramedic programs are factored in, i.e., paramedics preventing other noncardiac disease-related deaths, and program costs are only attributed to cardiac arrests in direct proportion to their incidence with respect to all paramedic runs, the cost per cardiac arrest life saved is closer to $6,500. The authors caution that results of the study should not be generalized to other communities without consideration of variation in the factors described in the article. A paramedic program can be said to be cost-beneficial if it saves lives that could not have been saved otherwise at a cost that society is willing to pay. In this case, the per capita program cost of $3.00 was approved during a special-purpose property tax levy to cover its costs.