Modelling the effects of the reorganization of vascular services

Abstract

Abstract Background Vascular services are currently in a state of evolution in many areas. A study has been carried out to model the economic and outcome implications of possible reconfiguration of vascular services. Methods Computer modelling was carried out based on an urban area with a teaching hospital (TH) and four surrounding district hospitals (DGHs) serving a population of 1·8 million. Data for the model were derived from a number of sources including local activity analysis, record linkage for cross-boundary flows, local audit, prospective surveys and systematic literature reviews. Results Analysis demonstrated a number of key differences in service provision between the TH and DGHs which were consistent with findings from literature reviews. These included differences in the use of endovascular treatments and femorodistal bypass, differences in case-mix and rates of particular procedures, and differences in outcome as measured by mortality and amputation rates. Computer modelling examined a number of options for the reconfiguration of services, including variations on fully centralized and hub and spoke arrangements. Cost estimates suggested that centralization and hub and spoke would result in an increased cost of £1 240 000–1 430 000 per year for the entire service, with over 80 per cent of these costs being related to expected increases in activity. Consideration of a number of key areas suggested that the resultant changes would save approximately 20 lives, 65 amputations and seven strokes per year for the population under consideration. Conclusion Reconfiguration of vascular services is likely to be highly cost effective. There is little difference in expected cost and outcomes between fully centralized and hub and spoke arrangements but the latter is preferred on the basis of decreased shift of resources and strong patient preference for local services.