Cost-effectiveness of drone-delivered automated external defibrillators for cardiac arrest

Muhammad Maaz¹, K H Benjamin Leung², Justin J Boutilier³, Sze-Chuan Suen⁴, Paul Dorian⁵, Laurie J Morrison⁶, Damon C Scales⁷, Sheldon Cheskes⁸, Timothy C Y Chan⁹

Affiliations

¹ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: m.maaz@mail.utoronto.ca.
² Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada. Electronic address: benkh.leung@mail.utoronto.ca.
³ Telfer School of Management, University of Ottawa, Ottawa, ON, Canada. Electronic address: boutilier@telfer.uOttawa.ca.
⁴ Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA. Electronic address: ssuen@usc.edu.
⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Unity Health Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada. Electronic address: Paul.Dorian@unityhealth.to.
⁶ Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: laurie.morrison@sunnybrook.ca.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: Damon.Scales@sunnybrook.ca.
⁸ Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: sheldon.cheskes@sunnybrook.ca.
⁹ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: tcy.chan@utoronto.ca.

PMID: 39970977
DOI: 10.1016/j.resuscitation.2025.110552

Cost-effectiveness of drone-delivered automated external defibrillators for cardiac arrest

Muhammad Maaz et al. Resuscitation. 2025 Apr.

. 2025 Apr:209:110552.

doi: 10.1016/j.resuscitation.2025.110552. Epub 2025 Feb 17.

Authors

Muhammad Maaz¹, K H Benjamin Leung², Justin J Boutilier³, Sze-Chuan Suen⁴, Paul Dorian⁵, Laurie J Morrison⁶, Damon C Scales⁷, Sheldon Cheskes⁸, Timothy C Y Chan⁹

Affiliations

¹ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: m.maaz@mail.utoronto.ca.
² Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada. Electronic address: benkh.leung@mail.utoronto.ca.
³ Telfer School of Management, University of Ottawa, Ottawa, ON, Canada. Electronic address: boutilier@telfer.uOttawa.ca.
⁴ Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA. Electronic address: ssuen@usc.edu.
⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Unity Health Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada. Electronic address: Paul.Dorian@unityhealth.to.
⁶ Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: laurie.morrison@sunnybrook.ca.
⁷ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada; Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: Damon.Scales@sunnybrook.ca.
⁸ Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: sheldon.cheskes@sunnybrook.ca.
⁹ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. Electronic address: tcy.chan@utoronto.ca.

PMID: 39970977
DOI: 10.1016/j.resuscitation.2025.110552

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) is a significant cause of mortality and morbidity in North America, for which timely defibrillation of shockable rhythms is essential. Drones have been proposed as an intervention to improve response time and are being implemented in practice.

Aim: To determine the cost-effectiveness of drone-delivered automated external defibrillators (AEDs) for OHCAs.

Methods: Using data from 22,017 OHCAs in Ontario, Canada over 10 years, we developed a comprehensive computational framework combining machine learning, optimization and a Markov microsimulation model to provide an economic evaluation of 964 different drone networks across a wide range of sizes and configurations. We simulated response times, survival outcomes, lifetime quality-adjusted life-years (QALYs), lifetime healthcare costs, and 10-year operational costs for each network.

Results: All 964 drone networks were cost-effective. We identified 20 networks on the cost-QALY efficient frontier, each with shorter response times, more survivors across all categories, and higher costs per survivor. Historical ambulance response (i.e., standard care) had mean response time of 6 min 21 s. On the efficient frontier, average drone response times were 32% to 71% shorter than standard care. There were 1,855 (8.4%) survivors to hospital discharge in standard care, which increased by 21% to 46% across the 20 drone networks. The smallest non-dominated drone network, with 20 drones, cost $20,912 per QALY gained. All drone networks had higher net monetary benefit than standard care. Cost-effectiveness was even greater for shockable and witnessed populations. Extensive sensitivity analyses showed that our results were robust to changes in modelling assumptions.

Conclusions: Drone-delivered AEDs were associated with reductions in response time, mortality and morbidity, and were found to be highly cost-effective relative to standard ambulance response with no drones.

Keywords: Automated external defibrillator; Cost-effectiveness analysis; Drone; Drone delivery; Out-of-hospital cardiac arrest.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SC has received grant funding from the Cardiovascular Network of Canada (Canet) and Zoll Medical Inc. for research on the use of drones to deliver AED in rural and remote cardiac arrest, and sits on the advisory board of Drone Delivery Canada. SC and LJM are on the editorial board of Resuscitation.

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Cost-effectiveness of drone-delivered automated external defibrillators for cardiac arrest

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Cost-effectiveness of drone-delivered automated external defibrillators for cardiac arrest

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical