Cost-utility analysis of the British Cardiovascular Interventional Society conveyance algorithm for patients with out-of-hospital cardiac arrest
Cost-utility analysis of the British Cardiovascular Interventional Society conveyance algorithm for patients with out-of-hospital cardiac arrest
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.
British Cardiovascular Interventional Society, Decision tree, Economic evaluation, Markov model, OHCA conveyance algorithm, Out-of-hospital cardiac arrest
Movio, Guilherme
a064bd55-2bb6-4969-8605-06788d4c071b
Sajjad, Uzma
f6e151b5-ed97-42f1-b938-b91003def5d4
Simpson, Rupert
52628207-e6df-4f5c-9a3b-ad118d2c21ca
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Movio, Guilherme
a064bd55-2bb6-4969-8605-06788d4c071b
Sajjad, Uzma
f6e151b5-ed97-42f1-b938-b91003def5d4
Simpson, Rupert
52628207-e6df-4f5c-9a3b-ad118d2c21ca
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Movio, Guilherme, Sajjad, Uzma and Simpson, Rupert
,
et al.
(2026)
Cost-utility analysis of the British Cardiovascular Interventional Society conveyance algorithm for patients with out-of-hospital cardiac arrest.
Resuscitation, [111021].
(doi:10.1016/j.resuscitation.2026.111021).
Abstract
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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Accepted/In Press date: 8 February 2026
e-pub ahead of print date: 18 February 2026
Keywords:
British Cardiovascular Interventional Society, Decision tree, Economic evaluation, Markov model, OHCA conveyance algorithm, Out-of-hospital cardiac arrest
Identifiers
Local EPrints ID: 510226
URI: http://eprints.soton.ac.uk/id/eprint/510226
ISSN: 0300-9572
PURE UUID: 5f132a5b-c171-45ff-a6cc-6fde9cbeaa43
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Date deposited: 23 Mar 2026 18:04
Last modified: 28 Mar 2026 02:41
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Author:
Guilherme Movio
Author:
Uzma Sajjad
Author:
Rupert Simpson
Corporate Author: et al.
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