This systematic review included ten economic evaluations of prehospital out-of-hospital cardiac arrest strategies, mostly cost-utility analyses, with six using Markov models. Prehospital ECPR was reported as more cost-effective than in-hospital ECPR, with incremental cost-effectiveness ratios ranging from AUD $27,323 to $44,000 per quality-adjusted life-year gained. Survival and neurological outcomes influenced cost-effectiveness estimates, while almost all studies reported fewer than 40% of assessed equity criteria. The authors concluded that many strategies enabling earlier advanced care were cost-effective, but heterogeneous comparators and sparse equity reporting limited evidence certainty.
These findings may inform resuscitation-system economic discussions, particularly around prehospital ECPR. They do not establish a survival advantage, and heterogeneous comparisons limit confidence in applying the estimates across settings.
Study limitation: The evidence primarily comprised economic evaluations, often using Markov models, with heterogeneous comparators and sparse equity reporting.
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