Therapeutic hypothermia after cardiac arrest is cost-effective

A brain-preserving cooling treatment called therapeutic hypothermia is a cost-effective way to improve outcomes after out-of-hospital cardiac arrest, which claims the lives of more than 300,000 people each year in the United States and leaves thousands of others neurologically devastated.

The treatment, which lowers body temperature to prevent damage to the brain and other major organs when blood flow is restored to the body following cardiac arrest, is considered a “good value” when compared to many other accepted and widely utilized medical treatments, including dialysis for kidney failure or complex heart surgeries, according to new University of Pennsylvania School of Medicine research published this week in Circulation: Cardiovascular Quality and Outcomes.

“Having already established that hypothermia improves neurological outcomes after cardiac arrest, we now know that the therapy is also a good use of health care resources,” says lead author Raina M. Merchant, MD, MS, an emergency physician and Robert Wood Johnson Clinical Scholar at Penn Medicine. “We hope our findings will help more hospitals and insurers to adopt cooling protocols and help more survivors return to productive lives.”

Despite national recommendations established in 2005 calling for out-of-hospital cardiac arrest patients to be treated with hypothermia when they remain comatose after resuscitation, many hospitals still don’t offer the intervention. Among barriers to its use: Concerns about its cost, and difficulty coordinating the interdisciplinary resources and staff needed to employ the treatment. Merchant and her colleagues used a complex mathematical design to measure quality-adjusted survival after cardiac arrest, cost of hypothermia equipment and treatment, and cost of post-hospital discharge care. Factors affecting costs included additional nursing care required during cooling treatment, extra time spent in the intensive care unit and post-discharge care required. They found that hypothermia has a cost of less than $100,000 per quality-adjusted life year (QALY), a measurement designed to illustrate the gains in both extra years of life and quality of life from a particular treatment.

Previous research has shown that about six out-of-hospital cardiac arrest patients need to be treated with hypothermia in order for one additional patient to be discharged without the brain damage that characterizes many survivors. Even when the authors of the new study adjusted their model to increase the proportion of neurologically impaired survivors in the group who received hypothermia, results still showed favorable cost-effectiveness estimates for hypothermia.

The findings also revealed that hypothermia treatment is actually less expensive than other interventions that have been implemented to treat cardiac arrest across the United States, including widespread CPR and defibrillation training for the public. In addition, the new research is among few studies to examine the costs of caring for patients who survive cardiac arrest with neurological deficits – a tremendous burden for the health care system and family caregivers.

“There are very few treatments for cardiac arrest victims, and hypothermia stands out as the only therapy which can improve neurologic survival,” Merchant says. “Hospitals and physicians should promote rapid adoption of this treatment for patients, and cost should not be considered a barrier to use.”

Other authors of the study include Peter W. Groeneveld, MD, MS, Lance B. Becker, MD, Benjamin S. Abella, MD, MPhil, and David A. Asch, MD, MBA. The study was funded by the Robert Wood Johnson Foundation Clinical Scholars Program (Merchant) and a Career Development Transition Award from the Veterans Affairs Health Services research and Development Service (Groeneveld).

PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is currently ranked #3 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to the National Institutes of Health, received over $366 million in NIH grants (excluding contracts) in the 2008 fiscal year. Supporting 1,700 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System (UPHS) includes its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation’s top ten “Honor Roll” hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center, named one of the nation’s “100 Top Hospitals” for cardiovascular care by Thomson Reuters. In addition UPHS includes a primary-care provider network; a faculty practice plan; home care, hospice, and nursing home; three multispecialty satellite facilities; as well as the Penn Medicine at Rittenhouse campus, which offers comprehensive inpatient rehabilitation facilities and outpatient services in multiple specialties.