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Abstract
Objective To determine cost-effectiveness parameters for EEG monitoring in cardiac arrest prognostication.
Methods We conducted a cost-effectiveness analysis to estimate the cost per quality-adjusted life-year (QALY) gained by adding continuous EEG monitoring to standard cardiac arrest prognostication using the American Academy of Neurology Practice Parameter (AANPP) decision algorithm: neurologic examination, somatosensory evoked potentials, and neuron-specific enolase. We explored lifetime cost-effectiveness in a closed system that incorporates revenue back into the medical system (return) from payers who survive a cardiac arrest with good outcome and contribute to the health system during the remaining years of life. Good outcome was defined as a Cerebral Performance Category (CPC) score of 1–2 and poor outcome as CPC of 3–5.
Results An improvement in specificity for poor outcome prediction of 4.2% would be sufficient to make continuous EEG monitoring cost-effective (baseline AANPP specificity = 83.9%). In sensitivity analysis, the effect of increased sensitivity on the cost-effectiveness of EEG depends on the utility (u) assigned to a poor outcome. For patients who regard surviving with a poor outcome (CPC 3–4) worse than death (u = −0.34), an increased sensitivity for poor outcome prediction of 13.8% would make AANPP + EEG monitoring cost-effective (baseline AANPP sensitivity = 76.3%). In the closed system, an improvement in sensitivity of 1.8% together with an improvement in specificity of 3% was sufficient to make AANPP + EEG monitoring cost-effective, assuming lifetime return of 50% (USD $70,687).
Conclusion Incorporating continuous EEG monitoring into cardiac arrest prognostication is cost-effective if relatively small improvements in sensitivity and specificity are achieved.
Glossary
- AANPP=
- American Academy of Neurology Practice Parameter;
- CPC=
- Cerebral Performance Category;
- GCS=
- Glasgow Coma Scale;
- HUI-3=
- Health Utility Index Mark 3;
- NSE=
- neuron-specific enolase;
- QALY=
- quality-adjusted life year;
- SSEP=
- somatosensory evoked potentials;
- WTP=
- willingness to pay
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received April 5, 2019.
- Accepted in final form January 10, 2020.
- © 2020 American Academy of Neurology
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