Cost-Utility Analysis of the BCIS Conveyance Algorithm for Out-of-Hospital Cardiac Arrest Patients
Author(s)
Vasileios Kontogiannis, MSc1, Eoin Moloney, Msc1, Guilherme Movio, Dr.2, Uzma Sajjad, Dr.2, Rupert Simpson, Dr.2, Maria Maccaroni, Dr.2, Thomas R. Keeble, Dr.2, Mehdi Javanbakht, MSc, PhD1.
1Optimax Access, Southampton, United Kingdom, 2Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Essex, United Kingdom.
1Optimax Access, Southampton, United Kingdom, 2Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Essex, United Kingdom.
OBJECTIVES: Out-of-Hospital Cardiac Arrest (OHCA) poses a significant challenge to healthcare systems, with high mortality rates and substantial intensive care costs. The British Cardiovascular Intervention Society (BCIS) OHCA conveyance algorithm centralises post-arrest care for patients with a likely cardiac cause at Cardiac Arrest Centres (CACs), aiming to improve survival through specialised treatment. This study evaluated the cost-effectiveness of implementing the BCIS OHCA conveyance algorithm in a large regional population, to inform NHS policy on optimising patient outcomes and resource allocation.
METHODS: A hybrid decision-analytic model—incorporating a decision tree and Markov model—was developed to assess the algorithm’s cost-effectiveness compared to standard of care (SoC) over a lifetime horizon. Model inputs were derived from an observational pilot study and published literature. Costs and utilities were discounted at 3.5% annually, with results expressed in terms of the incremental cost-effectiveness ratio (ICER).
RESULTS: Implementation of the algorithm was cost-effective, with an ICER of £2,926 per quality-adjusted life year (QALY) gained. Compared to SoC, it reduced costs associated with the Intensive Care Unit (ICU), ward, post-assessment, and ambulance use. Costs associated with admission, neuroprognostication, and long-term care were higher with the algorithm. Probabilistic sensitivity analysis (PSA) demonstrated an 86.3% probability of cost-effectiveness at a £30,000 willingness-to-pay (WTP) threshold, and a 33.7% probability of being cost saving. Key drivers included the proportion of patients discharged from ICU with either good or poor neurological outcomes, and the proportion transferred to CACs. Scenario analyses explored alternative assumptions, with only one analysis exceeding the WTP threshold set by the National Institute for Health and Care Excellence (NICE).
CONCLUSIONS: Centralised post-arrest care guided by the BCIS OHCA conveyance algorithm is a cost-effective strategy that supports improved long-term patient outcomes. The findings highlight the potential for more strategic use of NHS resources and reinforce the value of targeted investment in CAC infrastructure.
METHODS: A hybrid decision-analytic model—incorporating a decision tree and Markov model—was developed to assess the algorithm’s cost-effectiveness compared to standard of care (SoC) over a lifetime horizon. Model inputs were derived from an observational pilot study and published literature. Costs and utilities were discounted at 3.5% annually, with results expressed in terms of the incremental cost-effectiveness ratio (ICER).
RESULTS: Implementation of the algorithm was cost-effective, with an ICER of £2,926 per quality-adjusted life year (QALY) gained. Compared to SoC, it reduced costs associated with the Intensive Care Unit (ICU), ward, post-assessment, and ambulance use. Costs associated with admission, neuroprognostication, and long-term care were higher with the algorithm. Probabilistic sensitivity analysis (PSA) demonstrated an 86.3% probability of cost-effectiveness at a £30,000 willingness-to-pay (WTP) threshold, and a 33.7% probability of being cost saving. Key drivers included the proportion of patients discharged from ICU with either good or poor neurological outcomes, and the proportion transferred to CACs. Scenario analyses explored alternative assumptions, with only one analysis exceeding the WTP threshold set by the National Institute for Health and Care Excellence (NICE).
CONCLUSIONS: Centralised post-arrest care guided by the BCIS OHCA conveyance algorithm is a cost-effective strategy that supports improved long-term patient outcomes. The findings highlight the potential for more strategic use of NHS resources and reinforce the value of targeted investment in CAC infrastructure.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE310
Topic
Clinical Outcomes, Economic Evaluation, Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas