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Placing automated external defibrillators on most U.S. commercial airplanes would be as cost effective as car air bags

Cardiac arrest onboard an airplane is almost always fatal due to delays in emergency medical care. That's one reason why some airlines began installing automated external defibrillators (AEDs) on aircraft in the early 1990s. When trained laypersons in commercial aircraft use AEDs to revive cardiac arrest victims, victim survival rates are even higher than those achieved by emergency personnel. Placing AEDs on most U.S. commercial airplanes would be as cost effective as car air bags, according to a recent study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00028).

Stanford University researchers, led by Peter W. Groeneveld, M.D., analyzed the cost-effectiveness of various strategies of aircraft deployment of AEDs for a hypothetical group of persons experiencing cardiac arrest aboard U.S. commercial aircraft. They evaluated the impact of full deployment of AEDs on all aircraft and several strategies of partial deployment only on larger aircraft compared with no AEDs on aircraft (only training flight attendants in basic life support). They calculated that adding AEDs on passenger aircraft with more than 200 passengers would cost $35,300 per quality-adjusted life year (QALY) gained.

This compares favorably with other safety and health interventions. For example, installing driver-side airbags on cars costs $30,000 per QALY compared with no airbags, and installation of passenger-side airbags costs an additional $76,500 per QALY compared with driver-side airbags alone. Adding AEDs on aircraft with capacities between 100 and 200 passengers would cost an additional $40,800 per added QALY compared with deployment on large-capacity aircraft only. Full deployment on all passenger aircraft would cost an additional $94,700 per QALY gained compared with limited deployment on aircraft with capacity to carry more than 100 passengers. In 85 percent of simulations, AED placement on large-capacity aircraft produced cost-effectiveness ratios of less than $50,000 per QALY.

More details are in "Cost-effectiveness of automated external defibrillators on airlines," by Dr. Groeneveld, Jeanne L. Kwong, M.B.A., Yueyi Liu, M.S., and others, in the September 26, 2001 Journal of the American Medical Association 286(12), pp. 1482-1489.

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