{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T22:13:11Z","timestamp":1791151991335,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2003,8,12]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            Out-of-hospital cardiac arrest is frequent and has poor outcomes. Defibrillation by trained targeted nontraditional responders improves survival versus historical controls, but it is unclear whether such defibrillation is a good value for the money. Therefore, this study estimated the incremental cost effectiveness of defibrillation by targeted nontraditional responders in public settings by using decision analysis.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            A Markov model evaluated the potential cost effectiveness of standard emergency medical services (EMS) versus targeted nontraditional responders. Standard EMS included first-responder defibrillation followed by advanced life support. Targeted nontraditional responders included standard EMS supplemented by defibrillation by trained lay responders. The analysis adopted a US societal perspective. Input data were derived from published or publicly available data. Future costs and effects were discounted at 3%. Monte Carlo simulation and sensitivity analyses assessed the robustness of results. Standard EMS had a median of 0.47 (interquartile range [IQR]=0.32 to 0.69) quality-adjusted life years and a median of $14 100 (IQR=$8600 to $21 900) costs per arrest. Targeted nontraditional responders in casinos had an incremental cost of a median $56 700 (IQR=$44 100 to $77 200) per additional quality-adjusted life year. The results were sensitive to changes in time to defibrillation, incidence of arrest, and number of devices required to implement rapid defibrillation.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            Where cardiac arrest is frequent and response time intervals are short, rapid defibrillation by targeted nontraditional responders may be a good value for the money compared with standard EMS. The incidence of arrest should be considered when choosing locations to implement public access defibrillation.\n          <\/jats:p>","DOI":"10.1161\/01.cir.0000084545.65645.28","type":"journal-article","created":{"date-parts":[[2003,8,5]],"date-time":"2003-08-05T00:41:21Z","timestamp":1060044081000},"page":"697-703","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":76,"title":["Cost Effectiveness of Defibrillation by Targeted Responders in Public Settings"],"prefix":"10.1161","volume":"108","author":[{"given":"G.","family":"Nichol","sequence":"first","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Valenzuela","sequence":"additional","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Roe","sequence":"additional","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Clark","sequence":"additional","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Huszti","sequence":"additional","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.A.","family":"Wells","sequence":"additional","affiliation":[{"name":"From the Ottawa Health Research Institute (G.N., E.H., G.A.W.) and Department of Epidemiology and Community Medicine (G.N., G.A.W.), University of Ottawa, Ottawa, Canada; Department of Emergency Medicine (T.V., L.C.), University of Arizona, Tucson; and Division of Epidemiology and Biostatistics (D.R.), College of Public Health, University of Arizona, Tucson."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","unstructured":"Engelstein  ED Zipes  DP.  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