We will undertake a systematic review of the published peer-reviewed journal articles.
Study selection
We will include studies meeting any of the following inclusion criteria: patients with a cardiac arrest regardless of age, setting (in- and out-of-hospital cardiac arrest), countries, and any etiology (including traumatic) and costs clearly indicated as a currency value and year. If year is not explicit, we will assume that the year of publication could be used to adjust for inflation rate.
Both full and partial economic evaluation will be considered for inclusion in the present review, except those relying on modeling analyses.
We will exclude studies with any studies meeting any of the following inclusion criteria: studies examining sudden infant death syndrome or stillborn infants, modeling studies without primary collected cost data, all reviews without original data, conference abstracts, and syllabi.
Outcome measures
The primary outcome will include estimates of the range of total absolute costs related to care of cardiac arrest patients’ reported at an individual level.
The secondary outcomes will include description of costs related to the different time intervals of setting of care (i.e., prehospital, in-hospital, rehabilitation, long-term care facility, and outpatient) over which the economic evaluations have been undertaken.
Search strategy
With the help of an information specialist, we will design our search strategy to capture all potential costs associated with care of the cardiac arrest patient. Our search strategy will include (but will not be limited to) variations on the terms “cardiac arrest,” “cardiopulmonary resuscitation,” and “ventricular fibrillation” as well as validated search filter [
13,
14] for economic-related terms including “cost,” “economics,” “expenditure,” and “value” amongst others. Our search will be limited to original published manuscripts in peer-reviewed journals, dating back to 1991, when the first American Heart Association guidelines for cardiac arrest management were published. We will include only human studies. Our search will be carried out in MEDLINE, Embase, Ovid EBM reviews (ACP Journal Club, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment, NHS Economic Evaluation Database), and Web of Science (Science Citation Index Expanded). Specific search strategies will be employed for each database.
We will evaluate the risk of bias using the Drummond checklist, as recommended by the Cochrane Handbook Chapter 15 [
16]. Briefly, the Drummond checklist explores the different domains of cost analysis, i.e., study design, data collection and analysis, and interpretation of results [
17].
Data will be extracted onto a customized data extraction sheet by two independent reviewers (JG and GG). Any disagreement will be resolved through discussion, with arbitration by a third reviewer (LJM) if necessary.
Variables to be extracted will include:
-
First author, year of publication, and journal
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Country of origin
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Setting for care delivery (prehospital, inpatient, outpatient, long-term care, and rehab)
-
Baseline cardiac arrest characteristics (age, gender, initial shockable rhythm, location of cardiac arrest, presence of witness, bystander CPR, collapse to discharge survival rate) and outcomes of cardiac arrest (admission to discharge survival rate, return of spontaneous circulation (ROSC)). Initial shockable rhythm, presence of witness, and bystander CPR are binary variables and will be presented as the proportion of patients who met this condition during the acute episode.
-
Setting of cardiac arrest (out-of-hospital or in-hospital) and cause of cardiac arrest (medical or traumatic)
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Age category of patients (pediatrics, adults, and adults older than 65 years old)
The different settings will be defined as follows: the prehospital setting from the emergency service call until the arrival to the emergency department, the in-hospital setting including stays at both emergency department and inpatients wards, and the post-discharge setting including outpatients, rehabilitation, and long-term care facilities. A breakdown by country will be performed as well.
Authors of retrieved studies will be contacted if data extraction resulted in missing values.
Cost data will be abstracted as follows:
-
Reported currency, reported or presumed currency year
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Perspective of the analysis (i.e., payer): public payer, hospital, third party, or societal
-
Costs for each setting for care delivery (could include more than one in each study) the authors assessed, as well as total costs
-
For inpatient costs, we will also collect the main components of costs that have been taken into account, when indicated, e.g., rooming charges, equipment, medications/pharmacy, laboratory, and physicians’ fees including overhead cost and their definition which may differ across studies
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For in-hospital cardiac arrest, costs related to the resuscitation process will be collected separately when available
Costs will be extracted in “local currency.” After extraction, to make findings comparable, costing data not in US dollars will be converted to equivalent using the Organization for Economic Co-operation and Development “Purchasing Power Parities (PPP) for gross domestic product” dataset for the year of publication (
http://www.oecd.org
/). When a PPP from OECD is not available, conversion rates given within the manuscript details will be used. The healthcare-specific Consumer Price Index (
http://www.bls.gov/cpi/
) will then be used to adjust for inflation. All values in the review will therefore be presented in 2015 US dollars. Costs related to the management of these different settings will be reported as they are provided in the manuscript. Overall costs will be reported as well if they are provided in the original paper but will not result of the sum of the different components described above.
Findings will be presented in tables according to the study design perspective, the survival status at hospital discharge, the setting of arrest (out-of-hospital or in-hospital), the population (adults/pediatrics and adults older than 65 years old), and the time frame of cardiac arrest management (prehospital, in-hospital, rehabilitation, long-term care facilities, and outpatient). A breakdown by type of health care system (i.e., Anglo-American vs. French-German system) will be performed as well.