Objective: To examine the cost-effectiveness of deploying automated external defibrillators (AEDs) on U.S. passenger aircraft. Design: Decision and cost-effectiveness analysis. Estimates of the incidence of out-of-hospital cardiac arrest (OHCA) on board aircraft, effectiveness of AEDs in resuscitation, and medical costs and outcomes were derived from the medical literature. Equipment, maintenance, and flight attendant training costs were obtained from AED manufacturers, the Federal Aviation Administration, and the Air Transportation Association of America. Published estimates of health-related utility after OHCA were used to express effectiveness in quality-adjusted life years (QALYs) gained. Patients: Victims of cardiac arrest on U.S. commercial aircraft. Intervention: A strategy of full deployment on all commercial aircraft as well as several strategies of partial deployment only on larger aircraft were compared to the baseline strategy of no AEDs on aircraft, but flight attendants trained in basic life support (BLS). Results: Placing AEDs on passenger aircraft with greater than 200 passengers would cost $15,300 per QALY gained compared to no AEDs. Additional AEDs on aircraft with capacities between 100 and 200 would cost $37,800/QALY, and full deployment on all aircraft would cost $68,700/QALY. Sensitivity analyses indicated that the effectiveness of AEDs in improving survival, downstream quality-of-life, and the annual mortality rate were the most influential factors in the model. In a Monte Carlo analysis, 9950 of 10,000 trials produced a cost-effectiveness ratio less than $50,000 per QALY for AED placement on large-capacity aircraft. Conclusion: The use of AEDs on commercial aircraft is similar in cost-effectiveness to many widely accepted medical interventions and health policy regulations, but is critically dependent on the passenger capacity of the aircraft. Sensitivity analysis suggests this result is robust, even when underlying assumptions are varied widely. This study finds that placing AEDs on most U.S. commercial aircraft would meet conventional standards of cost-effectiveness.
