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Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects
BACKGROUND: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. METHODS: Using simulation modelling, three scenarios to improve decentralised se...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223548/ https://www.ncbi.nlm.nih.gov/pubmed/28073360 http://dx.doi.org/10.1186/s12874-016-0275-3 |
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author | Lahr, Maarten M. H. van der Zee, Durk-Jouke Luijckx, Gert-Jan Vroomen, Patrick C. A. J. Buskens, Erik |
author_facet | Lahr, Maarten M. H. van der Zee, Durk-Jouke Luijckx, Gert-Jan Vroomen, Patrick C. A. J. Buskens, Erik |
author_sort | Lahr, Maarten M. H. |
collection | PubMed |
description | BACKGROUND: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. METHODS: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER) per 1% increase in thrombolysis rate, and the proportion treated with thrombolysis. RESULTS: Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $US 1,834 (95% CI, 1,823–1,843) whereas centralising to four and two hospitals led to $US 1,462 (95% CI, 1,451–1,473) and $US 1,317 (95% CI, 1,306–1,328), respectively (P < 0.001). The iCER of improving community hospitals was $US 113 (95% CI, 91–150) and $US 71 (95% CI, 59–94), $US 56 (95% CI, 44–74) when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8% and 21.2% (P = 0.120 and P = 0.001) in case of increasing centralisation. CONCLUSIONS: Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12874-016-0275-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5223548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52235482017-01-11 Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects Lahr, Maarten M. H. van der Zee, Durk-Jouke Luijckx, Gert-Jan Vroomen, Patrick C. A. J. Buskens, Erik BMC Med Res Methodol Research Article BACKGROUND: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. METHODS: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER) per 1% increase in thrombolysis rate, and the proportion treated with thrombolysis. RESULTS: Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $US 1,834 (95% CI, 1,823–1,843) whereas centralising to four and two hospitals led to $US 1,462 (95% CI, 1,451–1,473) and $US 1,317 (95% CI, 1,306–1,328), respectively (P < 0.001). The iCER of improving community hospitals was $US 113 (95% CI, 91–150) and $US 71 (95% CI, 59–94), $US 56 (95% CI, 44–74) when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8% and 21.2% (P = 0.120 and P = 0.001) in case of increasing centralisation. CONCLUSIONS: Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12874-016-0275-3) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-10 /pmc/articles/PMC5223548/ /pubmed/28073360 http://dx.doi.org/10.1186/s12874-016-0275-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Lahr, Maarten M. H. van der Zee, Durk-Jouke Luijckx, Gert-Jan Vroomen, Patrick C. A. J. Buskens, Erik Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title | Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title_full | Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title_fullStr | Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title_full_unstemmed | Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title_short | Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
title_sort | centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223548/ https://www.ncbi.nlm.nih.gov/pubmed/28073360 http://dx.doi.org/10.1186/s12874-016-0275-3 |
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