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Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction

Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction
Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction
OBJECTIVES: To quantify the health gains and costs associated with improving ambulance and thrombolysis response times for acute myocardial infarction.
DESIGN: A computer simulation model.
PATIENTS/SETTINGS: Patients experiencing acute myocardial infarction in England.
INTERVENTIONS: Improving the ambulance response time to 75% of calls reached within 8 minutes and the hospital arrival to thrombolysis time interval (door-to-needle time) to 75% receiving it within 30 minutes and 20 minutes, compared to best estimates of response times in the mid-1990s.
MAIN OUTCOME MEASURES: Deaths prevented, life years saved, and discounted cost per life year saved.
RESULTS: Improving the ambulance response to 75% of calls within 8 minutes resulted in an estimate of 5 deaths prevented or 57 life years saved per million population per year, with a discounted incremental cost per life year saved of 8540 pounds sterling over 20 years. The corresponding benefit of improving the door-to-needle time to 75% of myocardial infarction patients within 30 minutes was an estimated 2 deaths prevented and 15 life years saved per million population per year, with a discounted incremental cost per life year saved of between 10,150 pounds sterling to 54,230 pounds sterling over 20 years. Little further gain was associated with reaching the 20 minute target. Combining ambulance and thrombolysis targets resulted in 70 life years saved per million population per year.
CONCLUSIONS: Improving ambulance response times appears to be cost effective. Reducing door-to-needle time will have a smaller effect at an uncertain cost. Further benefits may be gained from reducing the time from onset of symptoms to starting thrombolysis.
myocardial infarction, research, econometric, health services research, standards, health care costs, cost-benefit analysis, computer simulation, population, patients, 80 and over, design, time factors, England, health, models, humans, economics, aged, ambulances, drug therapy, thrombolytic therapy, time, research support, statistics & numerical data
1472-0205
67-72
Chase, D.
723c480c-334e-4d5b-9157-47e23fc8bda5
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Cooper, K.
ea064f58-d71d-404a-bcf3-49d243b8825b
Davies, R.
3d22f8a6-7085-493c-864f-4cc1bcdebfc5
Quinn, T.
c2d05783-06f0-4eeb-a519-a6cd9b482b02
Raftery, J.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Chase, D.
723c480c-334e-4d5b-9157-47e23fc8bda5
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Cooper, K.
ea064f58-d71d-404a-bcf3-49d243b8825b
Davies, R.
3d22f8a6-7085-493c-864f-4cc1bcdebfc5
Quinn, T.
c2d05783-06f0-4eeb-a519-a6cd9b482b02
Raftery, J.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b

Chase, D., Roderick, P., Cooper, K., Davies, R., Quinn, T. and Raftery, J. (2006) Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction. Emergency Medicine Journal, 23 (1), 67-72. (doi:10.1136/emj.2004.023036).

Record type: Article

Abstract

OBJECTIVES: To quantify the health gains and costs associated with improving ambulance and thrombolysis response times for acute myocardial infarction.
DESIGN: A computer simulation model.
PATIENTS/SETTINGS: Patients experiencing acute myocardial infarction in England.
INTERVENTIONS: Improving the ambulance response time to 75% of calls reached within 8 minutes and the hospital arrival to thrombolysis time interval (door-to-needle time) to 75% receiving it within 30 minutes and 20 minutes, compared to best estimates of response times in the mid-1990s.
MAIN OUTCOME MEASURES: Deaths prevented, life years saved, and discounted cost per life year saved.
RESULTS: Improving the ambulance response to 75% of calls within 8 minutes resulted in an estimate of 5 deaths prevented or 57 life years saved per million population per year, with a discounted incremental cost per life year saved of 8540 pounds sterling over 20 years. The corresponding benefit of improving the door-to-needle time to 75% of myocardial infarction patients within 30 minutes was an estimated 2 deaths prevented and 15 life years saved per million population per year, with a discounted incremental cost per life year saved of between 10,150 pounds sterling to 54,230 pounds sterling over 20 years. Little further gain was associated with reaching the 20 minute target. Combining ambulance and thrombolysis targets resulted in 70 life years saved per million population per year.
CONCLUSIONS: Improving ambulance response times appears to be cost effective. Reducing door-to-needle time will have a smaller effect at an uncertain cost. Further benefits may be gained from reducing the time from onset of symptoms to starting thrombolysis.

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More information

Published date: 2006
Keywords: myocardial infarction, research, econometric, health services research, standards, health care costs, cost-benefit analysis, computer simulation, population, patients, 80 and over, design, time factors, England, health, models, humans, economics, aged, ambulances, drug therapy, thrombolytic therapy, time, research support, statistics & numerical data

Identifiers

Local EPrints ID: 61706
URI: https://eprints.soton.ac.uk/id/eprint/61706
ISSN: 1472-0205
PURE UUID: 6fa7273e-0595-4093-9b80-7d02a55a8b2a
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 08 Sep 2008
Last modified: 14 Mar 2019 01:52

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Contributors

Author: D. Chase
Author: P. Roderick ORCID iD
Author: K. Cooper
Author: R. Davies
Author: T. Quinn
Author: J. Raftery

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