Cost-utility analysis of the British Cardiovascular Interventional Society conveyance algorithm for patients with out-of-hospital cardiac arrest
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Authors
Movio, Guilherme
Sajjad, Uzma
Simpson, Rupert
Butt, Haroun
Ibrahim, Abdalla
Kontogiannis, Vasileios
Moloney, Eoin
Javanbakht, Mehdi
Maccaroni, Maria Rita
Clesham, Gerald
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2026
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BACKGROUND: Out-of-hospital cardiac arrest is associated with high mortality and substantial healthcare costs. The British Cardiovascular Interventional Society's conveyance algorithm prioritises direct transfer of patients with an initial shockable rhythm to specialist Cardiac Arrest Centres to support access to advanced cardiac intervention, neurocritical care, and structured rehabilitation. This study evaluated the cost-effectiveness of implementing the conveyance algorithm in a large regional population. METHODS: A hybrid decision-analytic model, combining a decision tree and Markov model was developed to assess the cost-effectiveness of the algorithm, compared with standard of care over a lifetime horizon. Model inputs were derived from a contemporary, observational pilot study. Health outcomes were expressed in quality-adjusted life years, and healthcare costs were discounted at an annual rate of 3.5%. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and net monetary benefit. RESULTS: The conveyance algorithm was cost-effective, with an incremental cost-effectiveness ratio of £2926 per quality-adjusted life year gained. Reductions in intensive care, hospital ward, post-assessment, and ambulance costs were partially offset by slightly higher costs related to admission, neuroprognostication, and longer-term care. Probabilistic analysis showed an 86.0% probability of cost-effectiveness at a willingness-to-pay threshold of £35, 000 per quality-adjusted life year. CONCLUSION: Selective rhythm-based transfer to specialist cardiac arrest centres improved resource efficiency with minimal additional cost. Although clinical outcome differences remain exploratory due to observational data, this economic evaluation supports further prospective, multi-centre evaluation to confirm broader clinical and health system benefits.
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Resuscitation