摘要BACKGROUND:Targeted temperature management(TTM)is a common therapeutic intervention,yet its cost-effectiveness remains uncertain.This study aimed to evaluate the real-world cost-effectiveness of TTM compared with that of conventional care in adult out-of-hospital cardiac arrest(OHCA)survivors using clinical patient-level data.METHODS:We conducted a retrospective cohort study at an academic medical center in the USA to assess the cost-effectiveness of TTM in adult non-traumatic OHCA survivors between 1 January,2019 and 30 June,2023.The primary outcome was survival to hospital discharge.Incremental cost-effectiveness ratios(ICERs)were calculated and compared with various decision makers'willingness to pay.Cost-effectiveness acceptability curves were utilized to evaluate the economic attractiveness of TTM.Uncertainty about the incremental cost and effect was explored with a 95%confidence ellipse.RESULTS:Among 925 non-traumatic OHCA survivors,only 30(3%)received TTM.After adjusting for potential confounders,the TTM group did not demonstrate a significantly lower cost(delta cost-$5,141,95%confidence interval[95%CI]:$-35,347 to $25,065,P=0.79)and higher survival to hospital discharge(delta effect 6%,95%CI:-11%to 23%,P=0.41).Additionally,a 95%confidence ellipse indicated uncertainty reflected by evidence that the true value of the ICER could be in any of the quadrants of the cost-effectiveness plane.CONCLUSION:Although TTM did not demonstrate a clear survival benefit in this study,its potential cost-effectiveness warrants further investigation with larger sample sizes.These findings highlight the need for additional research to optimize TTM use in OHCA care and inform resource allocation decisions.