School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
Eur J Cancer Care (Engl). 2012 Mar;21(2):158-68. doi: 10.1111/j.1365-2354.2011.01323.x. Epub 2012 Jan 9.
While evidence suggests that within specific cancer sites centralisation of services improves outcomes and quality of care, the economic impact of centralisation is unclear. This systematic review identified 19 studies that have investigated whether or not the centralisation of cancer services results in economies of scale, or is cost-effective, or increases the costs of accessing care for patients and their carers. Evidence from 13 studies suggests that increasing surgeon volumes are associated with cost reductions, although one study suggested that this relationship is U-shaped and the evidence is not consistent for hospital volumes and costs. Only one study demonstrated that centralisation was cost-effective with an incremental cost utility ratio of $5029 (€3616) per quality-adjusted life year gained. Consistent evidence from four studies suggested that centralised services increase the costs of accessing care for patients and their carers. Current evidence on the economic impact of centralisation of cancer services is limited and of poor quality. Therefore, it remains unclear whether centralisation results in economies of scale and is cost-effective. Future research should be based on a clear definition of the different components of centralisation in order to determine which aspects of centralisation are efficient and for which cancer subgroups.
虽然有证据表明，在特定的癌症部位，服务的集中化可以改善治疗效果和护理质量，但服务集中化的经济影响尚不清楚。本系统评价确定了 19 项研究，这些研究调查了癌症服务的集中化是否会带来规模经济，是否具有成本效益，或者是否会增加患者及其护理人员获得护理的成本。来自 13 项研究的证据表明，增加外科医生的手术量与成本降低有关，尽管有一项研究表明，这种关系呈 U 型，而且针对医院容量和成本的证据并不一致。只有一项研究表明，集中化具有成本效益，每获得一个质量调整生命年的增量成本效用比为 5029 美元（3616 欧元）。四项研究的一致证据表明，集中化的服务会增加患者及其护理人员获得护理的成本。目前关于癌症服务集中化的经济影响的证据有限且质量较差。因此，目前尚不清楚集中化是否会带来规模经济和成本效益。未来的研究应该基于对集中化的不同组成部分的明确定义，以确定集中化的哪些方面是有效的，以及对哪些癌症亚组有效。
