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The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England

BACKGROUND: The economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acut...

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Autores principales: Hunter, Rachael M., Fulop, Naomi J., Boaden, Ruth J., McKevitt, Christopher, Perry, Catherine, Ramsay, Angus I. G., Rudd, Anthony G., Turner, Simon J., Tyrrell, Pippa J., Wolfe, Charles D. A., Morris, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852958/
https://www.ncbi.nlm.nih.gov/pubmed/29540216
http://dx.doi.org/10.1186/s12961-018-0301-5
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author Hunter, Rachael M.
Fulop, Naomi J.
Boaden, Ruth J.
McKevitt, Christopher
Perry, Catherine
Ramsay, Angus I. G.
Rudd, Anthony G.
Turner, Simon J.
Tyrrell, Pippa J.
Wolfe, Charles D. A.
Morris, Stephen
author_facet Hunter, Rachael M.
Fulop, Naomi J.
Boaden, Ruth J.
McKevitt, Christopher
Perry, Catherine
Ramsay, Angus I. G.
Rudd, Anthony G.
Turner, Simon J.
Tyrrell, Pippa J.
Wolfe, Charles D. A.
Morris, Stephen
author_sort Hunter, Rachael M.
collection PubMed
description BACKGROUND: The economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acute stroke care in two metropolitan areas in England, namely London and Greater Manchester (GM), was used to analyse the economic implications of two different implementation strategies for major system change. METHODS: A decision analytic model was used to calculate difference-in-differences in costs and outcomes before and after the implementation of two major system change strategies in stroke care in London and GM. Values in the model were based on patient level data from Hospital Episode Statistics, linked mortality data from the Office of National Statistics and data from two national stroke audits. Results were presented as net monetary benefit (NMB) and using Programme Budgeting and Marginal Analysis (PBMA) to assess the costs and benefits of a hypothetical typical region in England with approximately 4000 strokes a year. RESULTS: In London, after 90 days, there were nine fewer deaths per 1000 patients compared to the rest of England (95% CI –24 to 6) at an additional cost of £770,027 per 1000 stroke patients admitted. There were two additional deaths (95% CI –19 to 23) in GM, with a total costs saving of £156,118 per 1000 patients compared to the rest of England. At a £30,000 willingness to pay the NMB was higher in London and GM than the rest of England over the same time period. The results of the PBMA suggest that a GM style reconfiguration could result in a total greater health benefit to a region. Implementation costs were £136 per patient in London and £75 in GM. CONCLUSIONS: The implementation of major system change in acute stroke care may result in a net health benefit to a region, even one functioning within a fixed budget. The choice of what model of stroke reconfiguration to implement may depend on the relative importance of clinical versus cost outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12961-018-0301-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-58529582018-03-21 The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England Hunter, Rachael M. Fulop, Naomi J. Boaden, Ruth J. McKevitt, Christopher Perry, Catherine Ramsay, Angus I. G. Rudd, Anthony G. Turner, Simon J. Tyrrell, Pippa J. Wolfe, Charles D. A. Morris, Stephen Health Res Policy Syst Research BACKGROUND: The economic implications of major system change are an important component of the decision to implement health service reconfigurations. Little is known about how best to report the results of economic evaluations of major system change to inform decision-makers. Reconfiguration of acute stroke care in two metropolitan areas in England, namely London and Greater Manchester (GM), was used to analyse the economic implications of two different implementation strategies for major system change. METHODS: A decision analytic model was used to calculate difference-in-differences in costs and outcomes before and after the implementation of two major system change strategies in stroke care in London and GM. Values in the model were based on patient level data from Hospital Episode Statistics, linked mortality data from the Office of National Statistics and data from two national stroke audits. Results were presented as net monetary benefit (NMB) and using Programme Budgeting and Marginal Analysis (PBMA) to assess the costs and benefits of a hypothetical typical region in England with approximately 4000 strokes a year. RESULTS: In London, after 90 days, there were nine fewer deaths per 1000 patients compared to the rest of England (95% CI –24 to 6) at an additional cost of £770,027 per 1000 stroke patients admitted. There were two additional deaths (95% CI –19 to 23) in GM, with a total costs saving of £156,118 per 1000 patients compared to the rest of England. At a £30,000 willingness to pay the NMB was higher in London and GM than the rest of England over the same time period. The results of the PBMA suggest that a GM style reconfiguration could result in a total greater health benefit to a region. Implementation costs were £136 per patient in London and £75 in GM. CONCLUSIONS: The implementation of major system change in acute stroke care may result in a net health benefit to a region, even one functioning within a fixed budget. The choice of what model of stroke reconfiguration to implement may depend on the relative importance of clinical versus cost outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12961-018-0301-5) contains supplementary material, which is available to authorized users. BioMed Central 2018-03-14 /pmc/articles/PMC5852958/ /pubmed/29540216 http://dx.doi.org/10.1186/s12961-018-0301-5 Text en © The Author(s). 2018 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
Hunter, Rachael M.
Fulop, Naomi J.
Boaden, Ruth J.
McKevitt, Christopher
Perry, Catherine
Ramsay, Angus I. G.
Rudd, Anthony G.
Turner, Simon J.
Tyrrell, Pippa J.
Wolfe, Charles D. A.
Morris, Stephen
The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title_full The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title_fullStr The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title_full_unstemmed The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title_short The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
title_sort potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in england
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852958/
https://www.ncbi.nlm.nih.gov/pubmed/29540216
http://dx.doi.org/10.1186/s12961-018-0301-5
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