Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation
Abstract Background We have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres fr...
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4678-9 |
| _version_ | 1818210802149097472 |
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| author | Peter McMeekin Darren Flynn Mike Allen Diarmuid Coughlan Gary A. Ford Hannah Lumley Joyce S. Balami Martin A. James Ken Stein David Burgess Phil White |
| author_facet | Peter McMeekin Darren Flynn Mike Allen Diarmuid Coughlan Gary A. Ford Hannah Lumley Joyce S. Balami Martin A. James Ken Stein David Burgess Phil White |
| author_sort | Peter McMeekin |
| collection | DOAJ |
| description | Abstract Background We have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres from 24 to 30. Methods We constructed a discrete event simulation (DES) to estimate the effectiveness and lifetime cost-effectiveness (from a payer perspective) using 1 year’s incidence of stroke in England. 2000 iterations of the simulation were performed comparing baseline 24 centres to 30. Results Of 80,800 patients admitted to hospital with acute stroke/year, 21,740 would be affected by the service reconfiguration. The median time to treatment for eligible early presenters (< 270 min since onset) would reduce from 195 (IQR 155–249) to 165 (IQR 105–224) minutes. Our model predicts reconfiguration would mean an additional 33 independent patients (modified Rankin scale [mRS] 0–1) and 30 fewer dependent/dead patients (mRS 3–6) per year. The net addition of 6 centres generates 190 QALYs (95%CI − 6 to 399) and results in net savings to the healthcare system of £1,864,000/year (95% CI -1,204,000 to £5,017,000). The estimated budget impact was a saving of £980,000 in year 1 and £7.07 million in years 2 to 5. Conclusion Changes in acute stroke service configuration will produce clinical and cost benefits when the time taken for patients to receive treatment is reduced. Benefits are highly likely to be cost saving over 5 years before any capital investment above £8 million is required. |
| first_indexed | 2024-12-12T05:22:23Z |
| format | Article |
| id | doaj.art-41df196429154360abb4bf6c12322eea |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-12T05:22:23Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-41df196429154360abb4bf6c12322eea2022-12-22T00:36:35ZengBMCBMC Health Services Research1472-69632019-11-0119111110.1186/s12913-019-4678-9Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulationPeter McMeekin0Darren Flynn1Mike Allen2Diarmuid Coughlan3Gary A. Ford4Hannah Lumley5Joyce S. Balami6Martin A. James7Ken Stein8David Burgess9Phil White10School of Health, Community and Education Studies, Northumbria UniversitySchool of Health and Social Care, Teesside UniversityNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West PeninsulaInstitute of Health and Society, Newcastle UniversityOxford University Hospitals NHS TrustInstitute of Neuroscience, Newcastle UniversityOxford UniversityNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West PeninsulaNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West PeninsulaClinical Research Network North East and North Cumbria, North East and North Cumbria Stroke Patient & Carer PanelInstitute of Neuroscience, Newcastle UniversityAbstract Background We have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres from 24 to 30. Methods We constructed a discrete event simulation (DES) to estimate the effectiveness and lifetime cost-effectiveness (from a payer perspective) using 1 year’s incidence of stroke in England. 2000 iterations of the simulation were performed comparing baseline 24 centres to 30. Results Of 80,800 patients admitted to hospital with acute stroke/year, 21,740 would be affected by the service reconfiguration. The median time to treatment for eligible early presenters (< 270 min since onset) would reduce from 195 (IQR 155–249) to 165 (IQR 105–224) minutes. Our model predicts reconfiguration would mean an additional 33 independent patients (modified Rankin scale [mRS] 0–1) and 30 fewer dependent/dead patients (mRS 3–6) per year. The net addition of 6 centres generates 190 QALYs (95%CI − 6 to 399) and results in net savings to the healthcare system of £1,864,000/year (95% CI -1,204,000 to £5,017,000). The estimated budget impact was a saving of £980,000 in year 1 and £7.07 million in years 2 to 5. Conclusion Changes in acute stroke service configuration will produce clinical and cost benefits when the time taken for patients to receive treatment is reduced. Benefits are highly likely to be cost saving over 5 years before any capital investment above £8 million is required.http://link.springer.com/article/10.1186/s12913-019-4678-9ThrombectomyAcute strokePredictive modelsHealth economics |
| spellingShingle | Peter McMeekin Darren Flynn Mike Allen Diarmuid Coughlan Gary A. Ford Hannah Lumley Joyce S. Balami Martin A. James Ken Stein David Burgess Phil White Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation BMC Health Services Research Thrombectomy Acute stroke Predictive models Health economics |
| title | Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation |
| title_full | Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation |
| title_fullStr | Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation |
| title_full_unstemmed | Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation |
| title_short | Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation |
| title_sort | estimating the effectiveness and cost effectiveness of establishing additional endovascular thrombectomy stroke centres in england a discrete event simulation |
| topic | Thrombectomy Acute stroke Predictive models Health economics |
| url | http://link.springer.com/article/10.1186/s12913-019-4678-9 |
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