Healthcare costs of expedited transport compared with standard care following out-of-hospital cardiac arrest: results from the EVIDENCE randomised controlled trial.
Resuscitation · 2026-04-10 · Randomised trial
Abstract
INTRODUCTION: We aimed to determine whether health system costs differed between two pre-hospital transportation processes for cardiac arrest; and by the timing of out of hospital cardiac arrest (OHCA): inside or outside business hours when extracorporeal cardio-pulmonary resuscitation (ECPR) was available. METHODS: A prospective costing analysis was undertaken from a health system perspective, alongside the EVIDENCE trial conducted across Greater Sydney, Australia. Healthcare use reflected all medical interventions for patients from paramedic contact to hospital discharge or death. Mean total and per-participant healthcare use and costs were reported by trial allocation, with differences assessed using non-parametric Kruskal-Wallis tests. RESULTS: All 197 randomised participants in EVIDENCE were included in the costing analysis (102 in the expedited arm; 95 patients in the standard care arm; mean age 55 years, 82% males). Mean hospital length of stay from admission to discharge: 15 days (SD: 23) for expedited; 17 days (SD: 26) for standard care; and 17 days (SD: 28) for admissions during ECPR hours, 14 days (SD: 19) outside hours. Mean costs per patient were AUD$60,780 (SD: $122,520) for the expedited group and $67,579 (SD: $135,326) for standard care. The difference in mean costs (-$6799) was not significant (95% CI: -$44,014 to $30,416). Mean costs per participant were $36,182 higher within ECPR hours, compared with outside ECPR hours (95% CI: $1554-72,918). CONCLUSIONS: Health system costs of expedited transport and standard care for patients with OHCA were comparable. Patients transported within, rather than outside, hospital business hours incurred greater healthcare costs. TRIAL REGISTRATION: ACTRN12621000668808.