Objective - To systematically review and appraise the quality of economic evaluations assessing centralisation of specialised healthcare services.ududMethods - A 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.ududResults - A 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.ududConclusions - Confounded 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.
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机译:目的-系统评估和评估评估专业医疗服务集中化的经济评估的质量。 ud udMethods-系统评估,以确定对任何专业医疗服务集中化的经济评估。可以比较所有专门医疗服务集中化的成本和后果的全面经济评估。 ud ud结果-共有64篇全文文章符合纳入标准,对纳入研究的方法学特征进行了评估。在英国进行了两项研究。大多数研究使用活动量作为集中程度的替代指标。用于评估集中化的方法是异构的。研究使用的研究设计和集中化方面有所不同。研究中存在主要局限性。只有12项研究报告了研究前景。 17项研究使用了不能真正代表成本的费用来评估成本结果。只有10个报告了其分析中使用的成本构成的详细分类。在14项研究中有必要贴现,但只有7项研究有报道。不到三分之一的研究包括了敏感性分析。鉴于服务的组织和医疗保健费用各不相同,所确定的研究是否适用于除进行研究之外的其他环境。集中化作为一个概念也已经被可变地和狭义地定义为特定服务的活动,可能无法反映集中化的更广泛方面。 ud ud结论-研究结果混乱且带有偏见而没有标准化方法的信息可能会误导决策者做出错误的决定在集中化。重要的是改进经济评估的方法和报告,以便提供更可靠和可转让的证据。在成本和健康结果的估算中,应考虑集中医疗保健的更多方面。
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