nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, March 19, 2010

From Japan: Defibrillators on Every Corner. Cost Effective?

The New England Journal of Medicine published a study this week on the impact of increasing the distribution of Automatic External Defibrillators (AED's) country-wide in Japan.  Out of 300K cardiac arrests, about 12K were cardiac in origin and had some heart activity that could respond to a shock (V-Fib).  Of this group 462 got zapped by a bystander using a nearby AED.

Got all that?  We're real interested in these 400 people now.  It turns out that 31% of these folks were alive with minimal residual problems one month later.  By comparison, only 14% of those who had a  handy bystander, but either no AED, or no willingness to act, were alive at one month.  Bystander acts-- 31%, bystander can't or won't --14%.

Now, getting out my #2 Medium Skilcraft eraseable writing instrument,

[Skip this math garbage down to the asterisk* if you wish]

I calculate that 1752 people lived without AEDs, and having an AED added another 146 survivors.  But wait, didn't we say that 14% would survive without it anyway.  So, let's substract that number from the AED pile.  Now we can attribute 125 saves to the AED.

*Back track.  Whadaya think?  127 million people, 300K arrests, 125 extra lives saved.  Sounds good (assuming these people stay alive a LOT longer than one month).

Now lets do the Comparative Effectiveness Analysis--something our government wants to get heavy into, in order to control costs. 

[Again, skip all this math blather and go down to the asterisk *]

I calculate that the cost to provide 4 AEDs per square kilometer (from their data) is about $1,500,000,000.00  (AED's are around $3K).  To service these we'll need employees, repair shops, vehicles, etc:  my estimate is about $20,000,000.00.  About 15% will need replacement each year (svc life 7yrs) at $215,000,000.00.  There's lots of incidentals, let's just say $2 billion dollars.  Now throw in another fact: a third of these survivors will have another arrest in 5 years.

*How does it sound now?  I calculate that the cost will be $16 million per life saved, for at least one month and maybe several years.

Has the money been spent wisely?  Do we go all out to save every life?  In Great Britain the government has set a value of about $54,000.00 per year of life in order to decide whether they will cover a given medical treatment.  If the cost is over this, and a patient like you is not likely to benefit by living one year more, "you're outta there."

My analysis is highly flawed, and superficial (So, to my critics:  don't bother).  People will get better at shocking people, AED costs may go down, or a hundred other things could occur that could improve the cost-benefit ratio.

But this is the type of analysis that will be done.  Is it in accord with your principles regarding the value of human life?  If resources can be better served elsewhere and some will die to save more, will your conscience be clear that a moral decision was made?

All this gives me chest pains.  Maybe I'd better get the AED ready.

Opinions are entirely my own.

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