Oral Themed Presentation
Background: : Cardiac arrest is a public health problem. In 2017, 7037 cardiac arrests occurred in children under 18 years old, resulting in a total of 450,368 life years lost(1). High-quality CPR is a key determinant for improving intact neurological outcome and survival rates amongst cardiac arrest victims(2-9). Conventional classroom-based Basic Life Support (BLS) training doesn’t result in good CPR skill acquisition and retention(10-13). Educational strategies like distributed practice (i.e. separating training into small sessions and dispersing over time)(14-18) and use of real-time feedback (on compression depth, rate, and recoil) (19-23) are effective at improving skill acquisition and retention. However, more frequent training and extra equipment use could potentially increase the costs of the training. In our study, we conducted an economic evaluation to examine both the costs and the effectiveness of distributed training relative to the BLS course.
Research Question: : What is the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback compared to conventional Basic Life Support training?
Methodology: : This economic evaluation is conducted from the perspective of the healthcare system, based on a randomized trial(24) examining the efficacy of distributed CPR training. Participants were assigned to receive either a BLS course only or monthly CPR training at the workplace on a mannequin with real-time feedback on CPR quality. CPR quality was measured as “CPR competency” defined as at least 90% compliance on compression depth, rate, and recoil in a 2-minute test session. At 12 months, we measured the proportion of participants achieving CPR competency in both groups. We calculated the costs of both educational programs, including direct costs to run the program, costs for clinical hour loss and costs of remediation if not achieving CPR competency (Figure 1). Incremental costs and effectiveness of the intervention relative to control were presented. Sensitivity analyses were conducted to evaluate the impact of variability in costs and effects on the cost-effectiveness of the intervention. Cost-effectiveness is presented as the incremental cost-effectiveness ratio (ICER) if the intervention is both more effective and costlier (Figure 2, Table 3).
Results: : A total of 87 participants completed the training at 12 months. Compared with BLS course, the distributed training group had a higher proportion of participants achieving CPR competency (14.6% vs 54.3%, incremental effectiveness: +39.7%) with decreased costs ($ 266.50 vs $194.88 per trainee, incremental costs: -$71.62) in base case analysis (i.e. the intervention dominates). The sensitivity analysis showed that the cost-effectiveness of intervention is robust to variabilities in costs and effectiveness, except for clinical hour loss costs (i.e. whether the healthcare system pays for the training time). When the training time is not protected by the healthcare system, the intervention still yields an ICER: $91.46/ extra CPR competency).
Discussion/Conclusions: : Workplace-based distributed CPR training with real-time feedback results in better CPR and decreased training costs when training time is protected by the healthcare system. Even in a setting when training time is not protected, distributed CPR training still resulted in good value of money. This research indicates that workplace-based distributed CPR training is feasible and provide evidence for decision-makers to inform adoption of this educational program in different settings