Cost and outcome implications of the organisation of vascular services

Michaels J, Brazier J, Palfreyman S, Shackley P, Slack R
Record ID 32000000834
Authors' objectives:

To evaluate the cost and quality implications of different possible organisational models for sub-specialist vascular services.

Authors' results and conclusions: Data analysis showed significant differences between districts in terms of the services on offer, rates of procedures and possible indicators of outcome. Key issues that were identified were the relationship between volume and outcome for particular procedures, access to carotid endarterectomy, differences in the availability and use of femoro-distal bypass and endovascular treatments, and differences in some outcome measures including mortality and rates of major amputation. The findings of local activity analysis were supported by those of the literature reviews. The effect of different treatments for peripheral vascular disease on QALY was estimated. Conjoint analysis showed a strong preference for the availability of local treatment. Modelling demonstrated that centralisation of services would be expected to lead to improved outcomes but with an increase in overall resource requirements, and the cost-effectiveness of some of the changes was estimated.
Authors' recommendations: The study has demonstrated a number of problems stemming from the current configuration of vascular services, which are leading to excess mortality and morbidity, including limb loss and stroke. There is a need to rationalise services, taking into account the demonstrated clinical benefits of sub-specialisation and patient preferences for local services. The compromise of 'hub and spoke' arrangements, with a variable range of facilities being provided locally through a service linked to a major centre would seem likely to best achieve this compromise for centres without sufficient workload to provide a full range of local services. Such an arrangement would also be relatively straightforward to achieve through a staged reconfiguration of services.
Authors' methods: Systematic review, Utility analysis, Economic evaluation, Decision-analysis model
Project Status: Completed
URL for project:
Year Published: 2000
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • England
  • Models, Organizational
  • Patient Satisfaction
  • Quality-Adjusted Life Years
  • Surveys and Questionnaires
  • Technology Assessment, Biomedical
  • Workload
  • Cost-Benefit Analysis
  • Outcome and Process Assessment, Health Care
  • Vascular Surgical Procedures
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
Contact Email:
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.