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Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries

A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore...

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Autores principales: Lilford, Richard, Nepogodiev, Dmitri, Chilton, Peter J, Watson, Samuel I, Erlangga, Darius, Diggle, Peter, Girling, Alan J, Sculpher, Mark
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977070/
https://www.ncbi.nlm.nih.gov/pubmed/33737285
http://dx.doi.org/10.1136/bmjgh-2020-004723
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author Lilford, Richard
Nepogodiev, Dmitri
Chilton, Peter J
Watson, Samuel I
Erlangga, Darius
Diggle, Peter
Girling, Alan J
Sculpher, Mark
author_facet Lilford, Richard
Nepogodiev, Dmitri
Chilton, Peter J
Watson, Samuel I
Erlangga, Darius
Diggle, Peter
Girling, Alan J
Sculpher, Mark
author_sort Lilford, Richard
collection PubMed
description A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context.
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spelling pubmed-79770702021-03-19 Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries Lilford, Richard Nepogodiev, Dmitri Chilton, Peter J Watson, Samuel I Erlangga, Darius Diggle, Peter Girling, Alan J Sculpher, Mark BMJ Glob Health Practice A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context. BMJ Publishing Group 2021-03-18 /pmc/articles/PMC7977070/ /pubmed/33737285 http://dx.doi.org/10.1136/bmjgh-2020-004723 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Practice
Lilford, Richard
Nepogodiev, Dmitri
Chilton, Peter J
Watson, Samuel I
Erlangga, Darius
Diggle, Peter
Girling, Alan J
Sculpher, Mark
Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title_full Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title_fullStr Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title_full_unstemmed Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title_short Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
title_sort methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977070/
https://www.ncbi.nlm.nih.gov/pubmed/33737285
http://dx.doi.org/10.1136/bmjgh-2020-004723
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