Dunscombe P, Roberts G
Northeastern Ontario Regional Cancer Centre, Sudbury, Canada.
Clin Oncol (R Coll Radiol). 2001;13(1):29-37. doi: 10.1053/clon.2001.9211.
Access to health care interventions can be impeded when significant patient travel is required. In this economic evaluation we compare, from a societal perspective, three scenarios for the delivery of radiation treatment to an idealized population of 1,600 patients distributed between two urban nodes (1,200 + 400 patients each) separated by up to 500 km. As it is implicitly assumed that the clinical outcome for those patients who access the system is independent of the service delivery model, this study constitutes a cost minimization analysis from a societal perspective. The costs to the health care system are based on an activity costing model developed by us and consistent with recent Canadian studies. The costs to the patient are approximated by a formula that includes direct costs (travel and accommodation) and indirect (time) costs, with the latter based on a human capital approach. A sensitivity analysis has been performed to confirm the robustness of our conclusions both to uncertainties in the input data and to the inclusion of time costs, the estimation of which remains controversial. From a societal cost perspective only, we show that outreach radiotherapy (central comprehensive facility and satellite) is the economically superior service delivery model for separations between 30 km and 170 km. Beyond 170 km, a fully decentralized service would be warranted if the only consideration were societal economic advantage.
当患者需要长途跋涉时，获得医疗保健干预措施可能会受到阻碍。在这项经济评估中，我们从社会角度比较了三种为理想化的1600名患者提供放射治疗的方案，这些患者分布在两个城市节点之间（每个节点分别有1200名和400名患者），相距最远500公里。由于隐含假设那些进入该系统的患者的临床结果与服务提供模式无关，因此本研究构成了从社会角度进行的成本最小化分析。医疗保健系统的成本基于我们开发的一种作业成本核算模型，该模型与加拿大最近的研究一致。患者的成本通过一个公式估算，该公式包括直接成本（旅行和住宿）和间接（时间）成本，后者基于人力资本方法。我们进行了敏感性分析，以确认我们的结论对于输入数据中的不确定性以及时间成本纳入的稳健性，时间成本的估算仍然存在争议。仅从社会成本角度来看，我们表明，对于相距30公里至170公里的情况，外展放射治疗（中央综合设施和卫星设施）是经济上更优的服务提供模式。超过170公里，如果唯一的考虑因素是社会经济优势，那么完全分散的服务将是合理的。
