Balami Joyce S, Ford Gary A, Buchan Alastair M, Gray Alastair, Francesconi Andrea, Collini Paolo, Candio Paolo
Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Neuroscience Department, Sheffield University Teaching Hospital, Sheffield, UK.
BMC Health Serv Res. 2024 Aug 7;24(1):902. doi: 10.1186/s12913-024-11290-8.
Comprehensive stroke centres across England have developed investment proposals, showing the estimated increases in mechanical thrombectomy (MT) treatment volume that would justify extending the standard hours to a 24/7 service provision. These investment proposals have been developed taking a financial accounting perspective, that is by considering the financial revenues from tariff income. However, given the pressure put on local health authorities to provide value for money services, an affordability question emerges. That is, at what additional MT treatment volume the additional treatment costs are offset by the additional health economic benefits, that is quality-adjusted life years (QALYs) and societal cost savings, generated by administering MT compared to standard care.
A break-even analysis was conducted to identify the additional MT treatment volume required. The incremental hospital-related costs associated with the 24/7 MT extension were estimated using information and parameters from four relevant business cases. The additional societal cost savings and health benefits were estimated by adapting a previously developed Markov chain-based model.
The additional hospital-related annual costs for extending MT to a 24/7 service were estimated at a mean of £3,756,818 (range £1,847,387 to £5,092,788). On average, 750 (range 246 to 1,571) additional eligible stroke patients are required to be treated with MT yearly for the proposed 24/7 service extension to be affordable from a health economic perspective. Overall, the additional facility and equipment costs associated with the 24/7 extension would affect this estimate by 20%.
These findings support the ongoing debate regarding the optimal levels of MT treatment required for a 24/7 extension and respective changes in hospital organisational activities. They also highlight a need for a regional-level coordination between local authorities and hospital administrations to ensure equity provision in that stroke patients can benefit from MT and that the optimal MT treatment volume is reached. Future studies should contemplate reproducing the presented analysis for different health service provision settings and decision making contexts.
英国各地的综合卒中中心已制定投资提案，显示了机械取栓（MT）治疗量的预计增加情况，这将证明将标准工作时间延长至全天候服务是合理的。这些投资提案是从财务会计角度制定的，即通过考虑关税收入的财务收益。然而，鉴于当地卫生当局面临提供物有所值服务的压力，一个可承受性问题出现了。也就是说，在额外的MT治疗量达到多少时，额外的治疗成本会被与标准治疗相比实施MT所产生的额外健康经济效益（即质量调整生命年（QALYs）和社会成本节约）所抵消。
进行了盈亏平衡分析，以确定所需的额外MT治疗量。使用来自四个相关商业案例的信息和参数，估计了与24/7 MT扩展相关的增量医院相关成本。通过调整先前开发的基于马尔可夫链的模型，估计了额外的社会成本节约和健康效益。
将MT扩展至24/7服务的额外年度医院相关成本估计平均为3756818英镑（范围为1847387英镑至5092788英镑）。从健康经济角度来看，平均每年需要额外750名（范围为246至1571名）符合条件的卒中患者接受MT治疗，才能使提议的24/7服务扩展具有可承受性。总体而言，与24/7扩展相关的额外设施和设备成本将使这一估计受到20%的影响。
这些发现支持了关于24/7扩展所需的MT治疗最佳水平以及医院组织活动相应变化的持续辩论。它们还强调了地方当局和医院管理部门之间进行区域层面协调的必要性，以确保公平提供服务，使卒中患者能够从MT中受益，并达到最佳的MT治疗量。未来的研究应考虑针对不同的卫生服务提供环境和决策背景重现所呈现的分析。
