Hiqa says none of defibrillator programmes is ‘cost effective’

A proposed plan to provide public access to defibrillators nationally would cost up to €90 million and save at most 11 lives, according to a new report.

The Health Information and Quality Authority (Hiqa) says none of the public access defibrillator programmes it evaluated is cost effective.

Former Minister for Health James Reilly commissioned the authority to undertake a health technology assessment of defibrillators after accepting the principal of a Bill published by independent senator Fergal Quinn.

The Public Health (Availability of Defibrillators) Bill 2013 requires the owners of 43,000 premises to install a defibrillator; among the designated places are hospitals, shops, churches, public buildings, pubs and sports clubs.

The assessment says a public access defibrillation programme has the potential to improve survival rates when people suffer cardiac arrest. However, a large number of additional defibrillators would be required, given the large number of people trained in CPR and uncertainty about where cardiac arrests occur.

It estimates a national system of public defibrillation could save the lives of between two and 11 people, over and above those who are treated in hospitals for cardiac arrest. The greatest number of lives would be saved by a widespread public system of defibrillation, as proposed in the legislation, but this would cost the health services €2.5 million, the public sector €20.8 million and the private sector €85 million.

Most of these costs would be incurred in the first year, through the acquisition of defibrillators.

The reports says Ireland already has a high spread of defibrillators in the community, but this system is not standardised, coordinated or linked to emergency medical services.

It says programmes could be made more cost effective through greater use of the devices. This could arise from the creation of a register of defibrillators, linked to the medical services, and greater public awareness. “However, there is no evidence to suggest that the required increase in utilisation is achievable.”

The assessment says it could be more cost effective to locate defibrillators in specific locations, rather than in particular types of buildings. Multiple years of data about the places where people have heart attacks would be required to increase certainty about these locations.

It states: “Any prospective programme should start by targeting the mandatory deployment of AEDs (automated external defibrillator) to locations with the highest incidence of out-of-hospital cardiac arrest”.

A defibrillator is a small, portable device that analyses the heart rhythm of a person who has experienced a cardiac arrest and delivers an electric shock through the chest wall if it detects a rhythm that can respond to defibrillation. The electrical current momentarily stuns the heart, stopping the abnormal rhythm and helping the heart resume normal electrical activity.

In 2012, the survival rate where heart attack victims received treatment from emergency medical services out of hospital was 5.2 per cent, slightly below the international average. However, 80 per cent of survivors are discharged from hospitals and half survive 10 years.