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Centralising and optimising decentralised stroke care systems: a simulation study on short-term costs and effects
Maarten M H Lahr1, Durk-Jouke van der Zee2, Gert-Jan Luijckx3
1Health Technology Assessment, Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands. m.m.h.lahr@umcg.nl.
BMC Medical Research Methodology
|January 12, 2017
Summary
Centralizing thrombolysis treatment significantly reduces patient costs compared to decentralized care. While this approach lowers expenses, it may slightly decrease thrombolysis rates.
Area of Science:
- Health economics
- Stroke care management
- Healthcare policy
Background:
- Centralizing thrombolysis services can offer significant benefits for stroke patient care.
- Optimizing decentralized stroke care requires careful evaluation of costs and effectiveness.
Purpose of the Study:
- To assess the short-term costs and effects of centralizing thrombolysis and optimizing care within a decentralized system.
- To compare different centralization scenarios for thrombolysis treatment from a policy maker's perspective.
Main Methods:
- Simulation modeling was used to compare three scenarios: improving care at nine separate hospitals, centralizing to four hospitals, and centralizing to two hospitals.
- Outcomes measured included annual mean costs per patient, incremental cost-effectiveness ratio (iCER), and thrombolysis treatment rates.
Main Results:
- Centralizing thrombolysis to two hospitals resulted in the lowest mean annual cost per patient ($US 1,317), significantly lower than improving decentralized care ($US 1,834).
- The incremental cost-effectiveness ratio (iCER) for centralizing to two hospitals was $US 56 per 1% increase in thrombolysis rate.
- Thrombolysis rates slightly decreased with increased centralization, from 22.4% to 21.2% when centralizing to two hospitals.
Conclusions:
- Centralizing thrombolysis treatment substantially lowers mean annual costs per patient compared to enhancing stroke care at multiple community hospitals.
- While cost-effective, centralizing thrombolysis may lead to small, negative impacts on overall thrombolysis rates.
