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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Methodological issues in economic evaluations of emergency transport systems in low-income and middle-income countries
AU - Lilford, R.
AU - Nepogodiev, D.
AU - Chilton, P.J.
AU - Watson, S.I.
AU - Erlangga, D.
AU - Diggle, P.
AU - Girling, A.J.
AU - Sculpher, M.
PY - 2021/3/18
Y1 - 2021/3/18
N2 - A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
AB - A recent systematic review identified few papers on the economic evaluation of systems for emergency transport of acutely ill or injured patients. In addition, we found no articles dealing with the methodological challenges posed by such studies in low-income or middle-income countries. We therefore carried out an analysis of issues that are of particular salience to this important topic. This is an intellectual study in which we develop models, identify their limitations, suggest potential extensions to the models and discuss priorities for empirical studies to populate models. First, we develop a general model to calculate changes in survival contingent on the reduced time to treatment that an emergency transport system is designed to achieve. Second, we develop a model to estimate transfer times over an area that will be served by a proposed transfer system. Third, we discuss difficulties in obtaining parameters with which to populate the models. Fourth, we discuss costs, both direct and indirect, of an emergency transfer service. Fifth, we discuss the issue that outcomes other than survival should be considered and that the effects of a service are a weighted sum over all the conditions and severities for which the service caters. Lastly, based on the above work, we identify priorities for research. To our knowledge, this is the first study to identify and frame issues in the health economics of acute transfer systems and to develop models to calculate survival rates from basic parameters, such as time delay/survival relationships, that vary by intervention type and context. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.
KW - Health economics
KW - controlled study
KW - economic evaluation
KW - empiricism
KW - human
KW - lowest income group
KW - middle income country
KW - review
KW - survival rate
KW - time to treatment
U2 - 10.1136/bmjgh-2020-004723
DO - 10.1136/bmjgh-2020-004723
M3 - Journal article
VL - 6
JO - BMJ Global Health
JF - BMJ Global Health
SN - 2059-7908
IS - 3
M1 - e004723
ER -