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Real-world cost-effectiveness of targeted temperature management in out-of-hospital cardiac arrest survivors: results from an academic medical center

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World Journal of Emergency Medicine 2025年第1期16卷 28-34页

作者： Wachira Wongtanasarasin daniel k.nishijima Wanrudee Isaranuwatchai Jeff rey S.Hoch Department of Emergency Medicine Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand Department of Emergency Medicine University of California Davis School of MedicineSacramento 95817USA Health Intervention and Technology Assessment Program Ministry of Public HealthBangkok 11000Thailand Institute of Health Policy Management and EvaluationUniversity of TorontoToronto M5T 3M6Canada Division of Health Policy and Management Department of Public Health SciencesUniversity of California Davis School of MedicineSacramento 95817USA Center for Healthcare Policy and Research University of California Davis School of MedicineSacramento 95817USA

BACkGROUND: Targeted temperature management(TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA) survivors using clinical patient-level ***: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios(ICERs) were calculated and compared with various decision makers' willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ***: Among 925 non-traumatic OHCA survivors, only 30(3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065, P=0.79) and higher survival to hospital discharge(delta effect 6%, 95% CI:-11% to 23%, P=0.41). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness ***: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.

关键词： Out-of-hospital cardiac arrest Targeted temperature management Cost-effectiveness Survival Real-world data

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