The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12961-018-0301-5 |
| _version_ | 1818041424702078976 |
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| author | Rachael M. Hunter Naomi J. Fulop Ruth J. Boaden Christopher McKevitt Catherine Perry Angus I. G. Ramsay Anthony G. Rudd Simon J. Turner Pippa J. Tyrrell Charles D. A. Wolfe Stephen Morris |
| author_facet | Rachael M. Hunter Naomi J. Fulop Ruth J. Boaden Christopher McKevitt Catherine Perry Angus I. G. Ramsay Anthony G. Rudd Simon J. Turner Pippa J. Tyrrell Charles D. A. Wolfe Stephen Morris |
| author_sort | Rachael M. Hunter |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-10T08:30:12Z |
| format | Article |
| id | doaj.art-8a04e6e9f3bf4fb28327429af2658f81 |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-12-10T08:30:12Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
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| series | Health Research Policy and Systems |
| spelling | doaj.art-8a04e6e9f3bf4fb28327429af2658f812022-12-22T01:56:07ZengBMCHealth Research Policy and Systems1478-45052018-03-0116111410.1186/s12961-018-0301-5The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in EnglandRachael M. Hunter0Naomi J. Fulop1Ruth J. Boaden2Christopher McKevitt3Catherine Perry4Angus I. G. Ramsay5Anthony G. Rudd6Simon J. Turner7Pippa J. Tyrrell8Charles D. A. Wolfe9Stephen Morris10Research Department of Primary Care and Population Health, Royal Free Medical School, University College LondonDepartment of Applied Health Research, University College LondonAlliance Manchester Business School, University of ManchesterDivision of Health & Social Care Research, School of Medicine, King’s College LondonAlliance Manchester Business School, University of ManchesterDepartment of Applied Health Research, University College LondonDivision of Health & Social Care Research, School of Medicine, King’s College LondonCentre for Primary Care, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of ManchesterAlliance Manchester Business School, University of ManchesterDivision of Health & Social Care Research, School of Medicine, King’s College LondonDepartment of Applied Health Research, University College LondonAbstract 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.http://link.springer.com/article/10.1186/s12961-018-0301-5economic evaluationstrokemajor system changeimplementationcost-effectivenessprogramme budgeting and marginal analysis |
| spellingShingle | Rachael M. Hunter Naomi J. Fulop Ruth J. Boaden Christopher McKevitt Catherine Perry Angus I. G. Ramsay Anthony G. Rudd Simon J. Turner Pippa J. Tyrrell Charles D. A. Wolfe Stephen Morris The potential role of cost-utility analysis in the decision to implement major system change in acute stroke services in metropolitan areas in England Health Research Policy and Systems economic evaluation stroke major system change implementation cost-effectiveness programme budgeting and marginal analysis |
| 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 | economic evaluation stroke major system change implementation cost-effectiveness programme budgeting and marginal analysis |
| url | http://link.springer.com/article/10.1186/s12961-018-0301-5 |
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