Skip Navigation


Journal of Public Health Advance Access originally published online on January 25, 2006
Journal of Public Health 2006 28(1):31-34; doi:10.1093/pubmed/fdi072
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/1/31    most recent
fdi072v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Singaroyan, R.
Right arrow Articles by Egdell, R. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Singaroyan, R.
Right arrow Articles by Egdell, R. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Is a target culture in health care always compatible with efficient use of resources? A cost-effectiveness analysis of an intervention to achieve thrombolysis targets



Robin Singaroyan

C. Alison Seed

Robin M. Egdell
Robin Singaroyan, Senior House Officer, C. Alison Seed, Specialist Registrar, Robin M. Egdell, Consultant Cardiologist, Department of Cardiology, Macclesfield District General Hospital, Victoria Road, Macclesfield, Cheshire SK10 3BL, UK

Address correspondence to Robin M. Egdell. Email: robegdell{at}hotmail.com

Background The UK government has attempted to improve the quality of health care in the National Health Service and minimize geographical variations in quality by imposing targets in certain areas of health care. The measures taken by local health economies to achieve these targets have not before been subjected to cost-effectiveness analysis. We have assessed the cost effectiveness of an intervention designed to achieve thrombolysis time targets.

Methods In the setting of a single district general hospital in England, we audited local pain-to-needle (PTN) and door-to-needle (DTN) times, before and after a £208 000 ({euro}310 000, $370 000) annual expenditure to improve performance against government targets. The intervention included the recruitment of additional nursing time in the Accident & Emergency Department and the use of a single bolus thrombolytic agent for all patients with ST elevation myocardial infarction. An economic evaluation was performed, based on the expected number of additional lives saved, extrapolated from a meta-analysis of previous thrombolysis trials.

Results The intervention reduced mean DTN time from 37.6 ± 5.9 minutes (mean ± SEM) to 27.6 ± 3.6 minutes (p = 0.06). The cost per life saved was £3 423 ± 850 ({euro}5 100 000, $6 100 000), the cost per life year gained was £222 184 ({euro}330 000, $390 000) and the cost per quality-adjusted life year (QALY) gained was £246 871 ({euro}370 000, $440 000).

Conclusion Although moderately successful at improving performance against government targets, this intervention to promote rapid thrombolysis proved to be an inefficient use of health-care resources. Strict government targets in health care may not always lead to efficient targeting of resources.

Keywords: cost effectiveness, DTN, QALY, thrombolysis


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.