Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods

Abstract

ObjectiveTo systematically review and appraise the quality of economic evaluations assessing centralisation of specialised healthcare services.MethodsA systematic review to identify economic evaluations on centralisation of any specialised healthcare service. Full economic evaluations comparing costs and consequences of centralisation of any specialised healthcare service were eligible for inclusion. Methodological characteristics of included studies were appraised using checklists adapted from recommended guidelines.ResultsA total of 64 full-text articles met the inclusion criteria. Two studies were conducted in the UK. Most of the studies used volume of activity as a proxy measure of centralisation. The methods used to assess centralisation were heterogeneous. Studies differed in terms of study design used and aspect of centralisation they considered. There were major limitations in studies. Only 12 studies reported the study perspective. Charges which are not true representation of costs were used by 17 studies to assess cost outcomes. Only 10 reported the detailed breakdown of the cost components used in their analysis. Discounting was necessary in 14 studies but was reported only in 7 studies. Sensitivity analyses were included by less than one-third of the studies. The applicability of the identified studies to a setting other than the one they were conducted in is questionable, given variations in the organisation of services and healthcare costs. Centralisation as a concept has also been variably and narrowly defined as activity of specific services which may not reflect the wider aspects of centralisation.ConclusionsConfounded and biased information coming from studies without standardised methods may mislead decision-makers towards making wrong decisions on centralisation. It is important to improve the methodology and reporting of economic evaluations in order to provide more robust and transferable evidence. Wider aspects of healthcare centralisation should be considered in the estimates of costs and health outcomes.

Distance to Specialist Care and Disease Outcomes in Inflammatory Bowel Disease

“…Several studies have proposed centralization of health care services to improve outcomes, minimize regional differences in the quality of care, and reduce costs. 30, 31 However, often centralized high volume centers offering specialized care are necessarily located in large metropolitan centers, leading to increased travel distance (and consequently, reduced access) for patients residing in less populated areas further away. 32 As demonstrated in our study, this increased travel distance may result in worse patient outcomes or reduce the benefit of getting specialized care.…”

Paediatric neurorehabilitation: finding and filling the gaps through the use of the Institute for Manufacturing strategic roadmapping method

“…Current squeezes on health budgets as well as a drive for specialisation of clinical expertise have meant that patients and their families often must travel long distances for their treatment 14. This is particularly true in paediatric neurorehabilitation where small patient numbers have traditionally meant that patients with severe disability often must travel across the country to access specialist services 9.…”

Perspectives on the underlying drivers of urgent and emergency care reconfiguration in Ireland

“…Within the acute hospital sector, there is an increasing tendency to reconfigure towards a more centralised and specialised model, particularly for complex care conditions . This is characterised by the consolidation of services across a region on fewer hospital sites serving a higher volume of patients, to improve efficiency and outcomes . Several studies have supported the benefits of high volume, specialised units for coronary, stroke, and major trauma patients because of an apparent association with better outcomes …”

“…It has also been argued that other factors such as geography and population needs may support a less centralised model in many contexts . Centralising care can have unexpected impacts on sub‐groups of the population . Some groups, such as the elderly, those with low socioeconomic status, and those with suboptimal transport access, may reduce their use of health care services when journey distances increase due to the increased costs associated with added travel .…”

“…2 This is characterised by the consolidation of services across a region on fewer hospital sites serving a higher volume of patients, to improve efficiency and outcomes. 3 Several studies have supported the benefits of high volume, specialised units for coronary, stroke, and major trauma patients because of an apparent association with better outcomes. 4-7…”