Publication

Centralising and optimising decentralised stroke care systems: A simulation study on short-term costs and effects

Lahr, M. M. H., van der Zee, D-J., Luijckx, G-J., Vroomen, P. C. A. J. & Buskens, E., 10-Jan-2017, In : BMC Medical Research Methodology. 17, 5, 12 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Lahr, M. M. H., van der Zee, D-J., Luijckx, G-J., Vroomen, P. C. A. J., & Buskens, E. (2017). Centralising and optimising decentralised stroke care systems: A simulation study on short-term costs and effects. BMC Medical Research Methodology, 17(5). https://doi.org/10.1186/s12874-016-0275-3

Author

Lahr, Maarten M. H. ; van der Zee, Durk-Jouke ; Luijckx, Gert-Jan ; Vroomen, Patrick C. A. J. ; Buskens, Erik. / Centralising and optimising decentralised stroke care systems : A simulation study on short-term costs and effects. In: BMC Medical Research Methodology. 2017 ; Vol. 17, No. 5.

Harvard

Lahr, MMH, van der Zee, D-J, Luijckx, G-J, Vroomen, PCAJ & Buskens, E 2017, 'Centralising and optimising decentralised stroke care systems: A simulation study on short-term costs and effects', BMC Medical Research Methodology, vol. 17, no. 5. https://doi.org/10.1186/s12874-016-0275-3

Standard

Centralising and optimising decentralised stroke care systems : A simulation study on short-term costs and effects. / Lahr, Maarten M. H.; van der Zee, Durk-Jouke; Luijckx, Gert-Jan; Vroomen, Patrick C. A. J.; Buskens, Erik.

In: BMC Medical Research Methodology, Vol. 17, No. 5, 10.01.2017.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Lahr MMH, van der Zee D-J, Luijckx G-J, Vroomen PCAJ, Buskens E. Centralising and optimising decentralised stroke care systems: A simulation study on short-term costs and effects. BMC Medical Research Methodology. 2017 Jan 10;17(5). https://doi.org/10.1186/s12874-016-0275-3


BibTeX

@article{0d76240665bb4b97aa593e77f057295f,
title = "Centralising and optimising decentralised stroke care systems: A simulation study on short-term costs and effects",
abstract = "Background: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system.Methods: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER) per 1{\%} increase in thrombolysis rate, and the proportion treated with thrombolysis.Results: Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $ US 1,834 (95{\%} CI, 1,823-1,843) whereas centralising to four and two hospitals led to $ US 1,462 (95{\%} CI, 1,451-1,473) and $ US 1,317 (95{\%} CI, 1,306-1,328), respectively (P <0.001). The iCER of improving community hospitals was $ US 113 (95{\%} CI, 91-150) and $ US 71 (95{\%} CI, 59-94), $ US 56 (95{\%} CI, 44-74) when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8{\%} and 21.2{\%} (P = 0.120 and P = 0.001) in case of increasing centralisation.Conclusions: Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected.",
keywords = "Stroke, Simulation models, Organisational model, Costs, Thrombolysis, TISSUE-PLASMINOGEN ACTIVATOR, ACUTE ISCHEMIC-STROKE, UNITED-STATES, POOLED ANALYSIS, THROMBOLYSIS, CENTERS, TRIALS, IMPLEMENTATION, INFARCTION, ALTEPLASE",
author = "Lahr, {Maarten M. H.} and {van der Zee}, Durk-Jouke and Gert-Jan Luijckx and Vroomen, {Patrick C. A. J.} and Erik Buskens",
year = "2017",
month = "1",
day = "10",
doi = "10.1186/s12874-016-0275-3",
language = "English",
volume = "17",
journal = "BMC Medical Research Methodology",
issn = "1471-2288",
publisher = "BMC",
number = "5",

}

RIS

TY - JOUR

T1 - Centralising and optimising decentralised stroke care systems

T2 - A simulation study on short-term costs and effects

AU - Lahr, Maarten M. H.

AU - van der Zee, Durk-Jouke

AU - Luijckx, Gert-Jan

AU - Vroomen, Patrick C. A. J.

AU - Buskens, Erik

PY - 2017/1/10

Y1 - 2017/1/10

N2 - Background: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system.Methods: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER) per 1% increase in thrombolysis rate, and the proportion treated with thrombolysis.Results: Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $ US 1,834 (95% CI, 1,823-1,843) whereas centralising to four and two hospitals led to $ US 1,462 (95% CI, 1,451-1,473) and $ US 1,317 (95% CI, 1,306-1,328), respectively (P <0.001). The iCER of improving community hospitals was $ US 113 (95% CI, 91-150) and $ US 71 (95% CI, 59-94), $ US 56 (95% CI, 44-74) when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8% and 21.2% (P = 0.120 and P = 0.001) in case of increasing centralisation.Conclusions: Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected.

AB - Background: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system.Methods: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals. Outcomes were annual mean and incremental costs per patient up to the treatment with thrombolysis, incremental cost-effectiveness ratio (iCER) per 1% increase in thrombolysis rate, and the proportion treated with thrombolysis.Results: Compared to current decentralised care, improving stroke care at individual community hospitals led to mean annual costs per patient of $ US 1,834 (95% CI, 1,823-1,843) whereas centralising to four and two hospitals led to $ US 1,462 (95% CI, 1,451-1,473) and $ US 1,317 (95% CI, 1,306-1,328), respectively (P <0.001). The iCER of improving community hospitals was $ US 113 (95% CI, 91-150) and $ US 71 (95% CI, 59-94), $ US 56 (95% CI, 44-74) when centralising to four and two hospitals, respectively. Thrombolysis rates decreased from 22.4 to 21.8% and 21.2% (P = 0.120 and P = 0.001) in case of increasing centralisation.Conclusions: Centralising thrombolysis substantially lowers mean annual costs per patient compared to raising stroke care at community hospitals simultaneously. Small, but negative effects on thrombolysis rates may be expected.

KW - Stroke

KW - Simulation models

KW - Organisational model

KW - Costs

KW - Thrombolysis

KW - TISSUE-PLASMINOGEN ACTIVATOR

KW - ACUTE ISCHEMIC-STROKE

KW - UNITED-STATES

KW - POOLED ANALYSIS

KW - THROMBOLYSIS

KW - CENTERS

KW - TRIALS

KW - IMPLEMENTATION

KW - INFARCTION

KW - ALTEPLASE

U2 - 10.1186/s12874-016-0275-3

DO - 10.1186/s12874-016-0275-3

M3 - Article

VL - 17

JO - BMC Medical Research Methodology

JF - BMC Medical Research Methodology

SN - 1471-2288

IS - 5

ER -

ID: 38881456