Regionalization of treatment for subarachnoid hemorrhage: a cost-utility analysis.
BACKGROUND
Previous studies have shown that for the treatment of subarachnoid hemorrhage (SAH), outcomes are improved but costs are higher at hospitals with a high volume of admissions for SAH. Whether regionalization of care for SAH is cost-effective is unknown.


RESULTS
In a cost-utility analysis, health outcomes for patients with SAH were modeled for 2 scenarios: 1 representing the current practice in California in which most patients with SAH are treated at the closest hospital and 1 representing the regionalization of care in which patients at hospitals with <20 SAH admissions annually (low volume) would be transferred to hospitals with > or =20 SAH admissions annually (high volume). Using a Markov model, we compared net quality-adjusted life-years (QALYs) and cost per QALY. Inputs were chosen from the literature and derived from a cohort study in California. Transferring a patient with SAH from a low- to a high-volume hospital would result in a gain of 1.60 QALYs at a cost of 10,548 dollars/QALY. For transfer to result in only borderline cost-effectiveness (50,000 dollars/QALY), differences in case fatality rates between low- and high-volume hospitals would have to be one fifth as large (2.2%) or risk of death during transfer would have to be 5 times greater (9.8%) than estimated in the base case.


CONCLUSIONS
Transfer of patients with SAH from low- to high-volume hospitals appears to be cost-effective, and regionalization of care may be justified. However, current estimates of the impact of hospital volume on outcome require confirmation in more detailed cohort studies.
Bardach
Naomi S
NS
School of Medicine, University of California, San Francisco, CA 94143-01, USA.
Olson
Scott J
SJ
Elkins
Jacob S
JS
Smith
Wade S
WS
Lawton
Michael T
MT
Johnston
S Claiborne
SC
D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003953:Diagnosis-Related Groups; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics* / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome