PDF(Pubmed)
Abstract：
BACKGROUND: Comprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care.
METHODS: A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.
RESULTS: The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.
CONCLUSIONS: These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.
METHODS: A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.
RESULTS: The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.
CONCLUSIONS: These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.
摘要：
背景：英格兰各地的综合中风中心已经制定了投资建议，显示机械血栓切除术（MT）治疗量的估计增加，这将有理由将标准时间延长至24/7服务提供。这些投资建议是从财务会计的角度制定的，这是通过考虑关税收入的财政收入。然而,鉴于地方卫生当局面临提供物有所值服务的压力，一个负担能力问题出现了。也就是说,在额外的MT治疗量下，额外的治疗费用被额外的健康经济效益所抵消，这是质量调整生命年(QALYs)和社会成本节约，与标准护理相比，通过管理MT产生的。
方法：进行了盈亏平衡分析，以确定所需的额外MT治疗量。使用来自四个相关业务案例的信息和参数估算了与24/7MT扩展相关的与医院相关的增量成本。通过采用先前开发的基于马尔可夫链的模型来估计额外的社会成本节约和健康益处。
结果：将MT扩展到24/7服务的额外医院相关年度费用估计为3,756,818英镑（范围为1,847,387英镑至5,092,788英镑）。平均而言,从健康经济的角度来看，拟议的24/7服务扩展每年需要750（246至1,571）其他符合条件的中风患者接受MT治疗。总的来说,与24/7扩展相关的额外设施和设备成本将影响这一估计20%。
结论：这些发现支持了关于24/7延长所需的最佳MT治疗水平和医院组织活动各自变化的持续辩论。他们还强调了地方当局和医院管理部门之间需要进行区域一级的协调，以确保中风患者可以从MT中受益并达到最佳的MT治疗量。未来的研究应该考虑针对不同的卫生服务提供设置和决策环境再现所提出的分析。
方法：进行了盈亏平衡分析，以确定所需的额外MT治疗量。使用来自四个相关业务案例的信息和参数估算了与24/7MT扩展相关的与医院相关的增量成本。通过采用先前开发的基于马尔可夫链的模型来估计额外的社会成本节约和健康益处。
结果：将MT扩展到24/7服务的额外医院相关年度费用估计为3,756,818英镑（范围为1,847,387英镑至5,092,788英镑）。平均而言,从健康经济的角度来看，拟议的24/7服务扩展每年需要750（246至1,571）其他符合条件的中风患者接受MT治疗。总的来说,与24/7扩展相关的额外设施和设备成本将影响这一估计20%。
结论：这些发现支持了关于24/7延长所需的最佳MT治疗水平和医院组织活动各自变化的持续辩论。他们还强调了地方当局和医院管理部门之间需要进行区域一级的协调，以确保中风患者可以从MT中受益并达到最佳的MT治疗量。未来的研究应该考虑针对不同的卫生服务提供设置和决策环境再现所提出的分析。
