Cost effectiveness of emergency ambulance services for patients that need cardiopulmonary resuscitation among government hospitals in Chonburi Province.

Abstract

This study aimed to find the cost effectiveness ratio of Advanced Life Support (ALS) ambulance units for patients that needed cardiopulmonary resuscitation (CPR) provided by government hospitals in Chonburi province. Based on a direct survey and secondary data from the province-level ALS database, unit costs were calculated in three ways, using three sets of assumptions. Four measures of effectiveness of ALS ambulance operations were used. The data were used to finally calculate the cost-effectiveness ratio, comparing hospitals with the same level of competency but with some practice variation, e.g. comparing hospitals that included a medical doctor and a nurse with a 4-month emergency specialty training as part of the ALS unit with those that did not. Results showed the calculation of unit costs was sensitive to the methodology, and the difference of unit cost values from different methodologies may be as high as 18.56%. The total number ALS operations during the study period were 1,266 times. Among them, there were 195 CPR cases. The success rate of cardiopulmonary resuscitation was 88.2%, the average response time was 13.67± 7.61 minutes, the success rate of intravenous fluid was 99.8% and the ratio of deaths within 30 days after the admission was 13.37%. Through incremental cost effectiveness ratio (ICER) analyses, the results suggested that comparing hospitals with a medical doctor in the ALS unit with those without a medical doctor, an increase of 1% in terms of the CPR success would lead to an additional (incremental) cost of 1,644.4 baht. The rates of CPR success between hospitals with a specialty emergency nurse on the ALS team or without were not different. This study highlighted some gaps in the ALS organization that could lead to further cost-saving and recommended that to increase the effectiveness of the operation, human capital management, where appropriate functions are assigned to the right personnel, would be crucial.