Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Glob Health. 2021 Mar;6(3). doi: 10.1136/bmjgh-2020-004723.
A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context.
最近的一项系统评价发现，关于急症或重伤患者紧急转运系统的经济评估方面的文献很少。此外，我们没有发现任何针对低收入和中等收入国家此类研究所提出的方法学挑战的文章。因此，我们对这一重要主题的特别突出问题进行了分析。这是一项智力研究，我们在其中建立模型，识别其局限性，提出对模型的潜在扩展，并讨论优先进行实证研究以充实模型的问题。首先，我们开发了一个通用模型，以计算在紧急转运系统设计旨在实现的治疗时间减少的情况下生存情况的变化。其次，我们开发了一个模型来估计在拟议的转运系统服务区域内的转移时间。第三，我们讨论了获取用于填充模型的参数的困难。第四，我们讨论了直接和间接的紧急转运服务成本。第五，我们讨论了应该考虑除生存以外的其他结果的问题，以及服务的效果是服务所针对的所有条件和严重程度的加权总和。最后，基于上述工作，我们确定了研究的优先事项。据我们所知，这是第一项针对急性转运系统的健康经济学中的问题进行识别和阐述，并开发模型来根据时间延迟/生存关系等基本参数计算生存率的研究，这些参数因干预类型和背景而异。
