Regionalization of treatment for subarachnoid hemorrhage: a cost-utility analysis.
Circulation
; 109(18): 2207-12, 2004 May 11.
Article
em En
| MEDLINE
| ID: mdl-15117848
ABSTRACT
BACKGROUND:
Previous studies have shown that for the treatment of subarachnoid hemorrhage (SAH), outcomes are improved but costs are higher at hospitals with a high volume of admissions for SAH. Whether regionalization of care for SAH is cost-effective is unknown. METHODS ANDRESULTS:
In a cost-utility analysis, health outcomes for patients with SAH were modeled for 2 scenarios 1 representing the current practice in California in which most patients with SAH are treated at the closest hospital and 1 representing the regionalization of care in which patients at hospitals with <20 SAH admissions annually (low volume) would be transferred to hospitals with > or =20 SAH admissions annually (high volume). Using a Markov model, we compared net quality-adjusted life-years (QALYs) and cost per QALY. Inputs were chosen from the literature and derived from a cohort study in California. Transferring a patient with SAH from a low- to a high-volume hospital would result in a gain of 1.60 QALYs at a cost of 10,548 dollars/QALY. For transfer to result in only borderline cost-effectiveness (50,000 dollars/QALY), differences in case fatality rates between low- and high-volume hospitals would have to be one fifth as large (2.2%) or risk of death during transfer would have to be 5 times greater (9.8%) than estimated in the base case.CONCLUSIONS:
Transfer of patients with SAH from low- to high-volume hospitals appears to be cost-effective, and regionalization of care may be justified. However, current estimates of the impact of hospital volume on outcome require confirmation in more detailed cohort studies.
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Temas:
ECOS
/
Aspectos_gerais
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Hemorragia Subaracnóidea
/
Transferência de Pacientes
/
Custos Hospitalares
/
Hospitais
Tipo de estudo:
Etiology_studies
/
Health_economic_evaluation
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Patient_preference
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Circulation
Ano de publicação:
2004
Tipo de documento:
Article
País de afiliação:
Estados Unidos