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

Authors : Nawaraj Bhattarai, Peter McMeekin, Christopher Price, Luke Vale

Abstract

Objective

To systematically review and appraise the quality of economic evaluations assessing centralisation of specialised healthcare services.

Methods

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.

Results

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.

Conclusions

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.

Citation: Nawaraj Bhattarai, Peter McMeekin, Christopher Price Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods BMJ Open 2016;6:e011214 doi:10.1136/bmjopen-2016-011214

Received: 20 January 2016 Revised: 30 March 2016 Accepted: 18 April 2016 Published: 6 May 2016

Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Acknowledgements

This review is a part of independent research arising out of the Doctoral Fellowship supported by the Institute of Health & Society, Newcastle University, and funded by The Health Foundation, London. The views and opinions expressed here are those of the authors and do not necessarily reflect those of The Health Foundation or Institute of Health & Society.

Contributors

All authors conceived the study. NB designed and executed the search strategy; reviewed and assessed the studies for inclusion; appraised and extracted information from the included studies; and wrote the manuscript. PM, CP and LV contributed to the critical revision of the manuscript and provided critical comments. All authors read and approved the final manuscript.

Funding

The Health Foundation, London.

Competing interests

None declared.