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World Journal of Emergency Medicine

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Real-world cost-effectiveness of targeted temperature management in out-of-hospital cardiac arrest survivors: results from an academic medical center

Wachira Wongtanasarasin1,2, Daniel K. Nishijima2, Wanrudee Isaranuwatchai3,4, Jeffrey S. Hoch5,6    

  1. 1 Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
    2 Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento 95817, USA
    3 Health Intervention and Technology Assessment Program, Ministry of Public Health, Bangkok 11000, Thailand
    4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3M6, Canada
    5 Division of Health Policy and Management, Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento 95817, USA
    6 Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento 95817, USA
  • Contact: Wachira Wongtanasarasin, Email: wachir_w@hotmail.com

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Abstract: BACKGROUND: Targeted temperature management (TTM) is a common therapeutic intervention, yet its cost-effectiveness remains uncertain. This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest (OHCA) survivors using clinical patient-level data.
METHODS: We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January, 2019 and 30 June, 2023. The primary outcome was survival to hospital discharge. Incremental cost-effectiveness ratios (ICERs) were calculated and compared with various decision makers’ willingness to pay. Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM. Uncertainty about the incremental cost and effect was explored with a 95% confidence ellipse.
RESULTS: Among 925 non-traumatic OHCA survivors, only 30 (3%) received TTM. After adjusting for potential confounders, the TTM group did not demonstrate a significantly lower cost (delta cost -$5,141, 95% confidence interval [95% CI]: $-35,347 to $25,065) and higher survival to hospital discharge (delta effect 6%, 95% CI: -11% to 23%). Additionally, a 95% confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.
CONCLUSION: Although TTM did not demonstrate a clear survival benefit in this study, its potential cost-effectiveness warrants further investigation with larger sample sizes. These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.

Key words: Out-of-hospital cardiac arrest, Targeted temperature management, Cost-effectiveness, survival, Real-world data