JAMA Intern Med

Home defibrillators: Effective but costly for sudden cardiac arrest prevention

October 29, 2025

While home automated external defibrillators (AEDs) are effective for witnessed shockable cardiac arrests, the indiscriminate purchase of AEDs for private homes is not cost-effective at current prices. Targeted deployment may be justified in select high-risk households, but broad adoption isn't supported by current evidence.

Study details: This large U.S. cohort study (N = 582,536) used data from the Cardiac Arrest Registry to Enhance Survival (2017–2024) to assess the effectiveness and cost-effectiveness of AEDs in private homes. A difference-in-difference approach estimated the causal impact of AED use on survival, and a decision-analytic model evaluated cost-effectiveness per quality-adjusted life-year (QALY) gained.

Results: AED application improved survival to hospital discharge in patients with a shockable rhythm (risk ratio, 1.26; 95% confidence interval, 1.01–1.57), but not in those with nonshockable rhythms. The incremental cost-effectiveness ratio for a home AED was $4,481,659 per QALY—far above the cost-effectiveness threshold of $200,000/QALY. Cost-effectiveness was only achieved if annual cardiac arrest incidence exceeded 1.3% or device cost dropped below $65 (not including bystander training cost).

Source:

Andersen LW, et al. (2025, October 25). JAMA Intern Med. Effectiveness and Cost-Effectiveness of Automated External Defibrillators in Private Homes: A Report From the Cardiac Arrest Registry to Enhance Survival. https://pubmed.ncbi.nlm.nih.gov/41137600/