Evidence map›Paper›PMID 31703684›Full record

ArticleBMC health services research2019

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation.

Peter McMeekin, Darren Flynn, Mike Allen, Diarmuid Coughlan, Gary A Ford, Hannah Lumley, Joyce S Balami, Martin A James, Ken Stein, David Burgess and 1 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Hub-and-spoke model for thrombectomy service in UK NHS practice.Clinical medicine (London, England) · 2021
    Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Peter McMeekinSchool of Health, Community and Education Studies, Northumbria University, Newcastle upon Tyne, UK.
Darren FlynnSchool of Health and Social Care, Teesside University, Tees Valley, UK.
Mike AllenNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, Bristol, UK.
Diarmuid CoughlanInstitute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.
Gary A FordOxford University Hospitals NHS Trust, Oxford, UK.
Hannah LumleyInstitute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, UK.
Joyce S BalamiOxford University, Oxford, UK.
Martin A JamesNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, Bristol, UK.
Ken SteinNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, Bristol, UK.
David BurgessClinical Research Network North East and North Cumbria, North East and North Cumbria Stroke Patient & Carer Panel, Newcastle upon Tyne, UK.
Phil WhiteInstitute of Neuroscience, Newcastle University, 3-4 Claremont Terrace, Newcastle upon Tyne, UK. phil.white@newcastle.ac.uk.ORCID http://orcid.org/0000-0001-6007-6013

Funding

Department of Health RP-PG-1211-20012Programme Grants for Applied Research RP-PG-1211-20012
6 · The paper itself

Abstract

backgroundWe have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres from 24 to 30.

methodsWe constructed a discrete event simulation (DES) to estimate the effectiveness and lifetime cost-effectiveness (from a payer perspective) using 1 year's incidence of stroke in England. 2000 iterations of the simulation were performed comparing baseline 24 centres to 30.

resultsOf 80,800 patients admitted to hospital with acute stroke/year, 21,740 would be affected by the service reconfiguration. The median time to treatment for eligible early presenters (< 270 min since onset) would reduce from 195 (IQR 155-249) to 165 (IQR 105-224) minutes. Our model predicts reconfiguration would mean an additional 33 independent patients (modified Rankin scale [mRS] 0-1) and 30 fewer dependent/dead patients (mRS 3-6) per year. The net addition of 6 centres generates 190 QALYs (95%CI - 6 to 399) and results in net savings to the healthcare system of £1,864,000/year (95% CI -1,204,000 to £5,017,000). The estimated budget impact was a saving of £980,000 in year 1 and £7.07 million in years 2 to 5.

conclusionChanges in acute stroke service configuration will produce clinical and cost benefits when the time taken for patients to receive treatment is reduced. Benefits are highly likely to be cost saving over 5 years before any capital investment above £8 million is required.

Indexed as

AgedAmbulatory Care FacilitiesBudgetsCost-Benefit AnalysisDelivery of Health CareEndovascular ProceduresEnglandFemaleHospitalizationHospitalsHumansMaleMiddle AgedQuality-Adjusted Life YearsState MedicineStrokeAcute strokeHealth economicsPredictive modelsThrombectomy

Identifiers

PMID31703684
PMCPMC6842187

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.