Sample Research Paper on Evaluating a Healthcare Intervention

Introduction

The maximum benefits of dual delivery defibrillation, particularly by ambulance and fire services, results from comprehensive Therapeutic Hypothermia (TH) protocols. When this defibrillation is integrated into the regional ST-segment elevation myocardial infarction network, patients gain the vast dispersion of the significance OHCA’s (Out-of-Hospital Cardiac Arrest) therapy.⁽¹⁾ The TH is the representative guideline for the OHCA where the transferred patients, from the regional hospitals, get the treatment. The catastrophic occurrences of the OHCA in the United States are shocking. Even though rates of survival after these devastating conditions are minimal, there are higher possibilities that the conditions may cause significant neurological sequelae alongside innumerable disabilities.⁽¹⁾ The minority of these individuals experience a return to the previous functional conditions. Accordingly, TH is an innovation with critical potential cardio-cerebral resuscitation therapy that enhance survival. The TH also alleviates the neurological effects among patients who are able to survive cardiac arrest. The comatose adults witnessed OHCA significantly benefit from the TH guideline. From the investigation, we realize that defibrillation system through the use of dual healthcare deliveries for OHCA is economically efficient. The efficient use of ambulance and fire services can be understood by performing analysis of the costs and benefits with reference to the healthcare services. On the same note, the study’s findings recommend a vast implementation of defibrillation program within similar elements to increase the chances of survival amongst the OHCA patients.

Objective of the Evaluation

The discussions presented in this report identify OHCA as a fatal disorder that needs a sound and urgent intervention. The defibrillation is an essential factor to improve the rates of survival among the OHCA patients.^{(2, 3)} The purpose of  this paper is to determine the economic impacts of service defibrillation by hospital ambulance and fire services with a reference to Stockholm County in Sweden. The evaluation entails performing an analysis of cost and benefit of defibrillation by fire services and ambulance. The analysis of cost and benefit will showcase economic impact of the two interventions and how they will help improve healthcare operations. The economic impact of the OHCA interventions will majorly stress on life duration, cost-effectiveness and quality of services that will help improve patient’s health status.⁽²⁾ This evaluation will add to the existing list of literature that provides information about the hospital cost of OHCA survivors. The evaluation focuses on the assessment of the cost-effectiveness of mentioned intervention to permit fair resource allocation within the National Health Service.

Economic Question

How can intervention through defibrillation positively affect the economy?

Intervention

Improving health conditions of patients through defibrillation or focusing on provision of ambulance and fire services in a selected OHCA intervention. The intervention is expected to have a positive economic impact when addressing OHCA challenges.

Comparator

The comparator of this intervention will be bystander approach to address the challenge of OHCA. The results of the anticipated intervention can be likened to the outcome of this comparator to showcase the economic impacts.

Method of the Intervention

The method designed to assist in the economic evaluation is the cost-benefit analysis, which is helpful in evaluating the impacts of the dual dispatch defibrillation together with the monetary value of life estimated at 2.2 million pound. This amount became useful towards the identification of healthcare benefits. ^{(4-6, 8)} The cost-benefit evaluation framework involved discounting to make-temporal comparison based on the net present value criterion. The expression about prices was through Euros pound and focused on Swedish CPI as a deflator to the rates of exchange. Based on this analysis, transportation costs could reduce by 4% and the duration considered a reflection of the life of the project. The transport cost will also represent a 10-year life span of the automated external defibrillator.⁽⁷⁾

Identifying, measuring and evaluating costs

The approximated cost includes the cost of defibrillation like maintenance costs, hospitalization charges and call-outs for the fire services, the cost of dispatch center, training and overhead resources. The estimated cost of every successful treatment was approximated to be 60,000 pounds and that of improved life quality approximated to be 13,000 pounds.

Cost elements	Resource	Cost in “1000” pounds
Material	Cost of acquiring AEDs Cost of acquiring AEDs Cost of acquiring AEDs	176 22 238
Training	The cost of Insurance service training The cost of training for Introductory services Refresher Training	28 345 2140
Hospitalization and Care Services	Hospitalization for client Costs on long durational and non-discharged patients.	1822 2464
Call-Outs	Costs for Emergency Call-outs	581
Dispatch center	Overhead and training	45
Total Cots		8129

 

 

Elements	Estimated Value	Overall  Benefit (€ 1000)	Overall cost (€ 1000)	Benefit-cost ratio
Starting position		300,000	9000	33
Saved lives -5 or +5 saves	11 lives every year 21 lives  every year	210,000 400,000	7000 10,000	30 40
VSL -50 % +50%	€ 1.2 million € 3.4 million	151,000 450,000	8200 8300	18 54
Rate of discount +1 or -1%	5 % 3 %	295000 310,124	8000 8500	36 36
an AED life-span +2 or -2 years	13 years 9 years	350,000 250,254	9400 7000	37 35
Cost of Hospitalization +50 or -50%	€ 21 000 € 7 000	300,000 300,000	9000 7300	34 42
Cost of healthcare services +100, +50 or -50%	€ 6900 € 5200 € 1600	310,000 310,000 310,000	9000 9300 7200	34 33 43

 

The benefits included the increased number of saved lives estimated at 16 lives annually, which produced a benefit-cost ratio of 36. According to this investigation, one of the benefits of the dispatching fire services for patients experiencing OHCA is the reduction in life complications.^(8-10) From the analysis, 43 fire stations in Stockholm County got the necessary equipment with AEDs. The equipment was shipped parallel to the service ambulance for the immediate response to patients experiencing OHCA. The release and delivery of the ambulance was done in a similar way to previously delivery process and time of response was distracted only when the fire service arrived to save situation. The intervention impacts were measured and evaluation followed in a pilot period between December first 2005   and 31^st 2006 where close to 860 OHCA patients were included in the resuscitation measures.⁽¹¹⁾ Out of the dual deliveries, the fire services were verified first on their arrival at the scene and used to initiate treatment in 36% of presented cases. During the service, it was noted that the average time from the first call to the initial defibrillation reduced from 9.2 to 8 minutes. The number of the survivors after one month rose to 7 from the initial 4 percent and this was statistically significant as demonstrated by the dual delivery or dispatch.⁽¹²⁾ The OHCA patients alongside the ones in ventricular fibrillation witnessed a rise in rates of survival. The approximated number of marginal lives following the intervention was 16 per annum.

Uncertainty or Sensitivity Analyses

The sensitivity analysis of individual variable per time showed the highest volatility impact on the number of lives saved as reflected by the benefit-cost ratios.

The Univariate sensitivity analysis

Presentation of Results

Analysis	Benefit	Costs in 1000-pound	Results in pound
Effectiveness based on the cost of delivery	16 lives saved every year	8219	60 000 for every life
Cost-consumption	77 QALY for every operational year	8219	13 000 for every QALY
Cost-advantage WTP	VSL close to 2.2 pound	8219	Costs and benefits =36

Benefits are put together and discounted over the life of the project

 

The results shows that application of the two-system defibrillation using both ambulance and fire services have positive economic impacts. The analysis of the cost and benefit, and return from the investment capital indicate that benefits are 36 times higher than the investment cost.⁽¹³⁾ There are also few comparable cost-benefit analysis studies available in the area of OHCA. The program has a higher potential to decrease and prevent sudden cardiac arrest deaths based on the implantable cardioverter-defibrillator (ICA).^(14,15) The conservative approach employed in the study leaves chances for the uncertainty linked to the VSL value for the OHCA. There is a surprise, however, these approximated figures are the same value indicated by VSL for the road control measures estimated at 2.4 pounds. The point of intersection for the OHCA values of VSL indicates that the benefit amounting to 60,000 pound.⁽¹⁶⁾ The conclusion of this value is that it is quite negligible, and this validate the beneficial impact of the intervention to society.

Comparison about the effectiveness of analysis of 60,000 pound against the cost-utility analysis of 13000 pound per QALY are components of the cost, which are appropriately analyzed. The optimal amount of 64 000 pound is usually employed by the NBHW (National Board of Health and Welfare), and represents the charge for every QALY, which could be lower when under the 11000 ad medium at 11000-54000 and high  when the values lies between 54000 and 108000 pounds⁽¹⁷⁾. Any value above the 108000 is consider high and as indicated by the results, standards measures are confirmatory to the positive impacts of the dual intervention of dispatch, hence this is an efficient program⁽¹⁸⁾. The economic efficiency for the program is that there is an increase in the speed of arrival at the scenes that improve the chances of performing the cardiopulmonary resuscitation.

The defibrillator is always developed and attached to the patient and the effect of this strategy is that there is an increased number of personnel to respond appropriately to the emergencies and this leads to higher survival rates ⁽¹⁹⁾. The increase in the number of personnel leads to the   increase in opportunities that comfort as well as support the OHCA patients and relative. For instance, the fire service will still be used even for a longer duration upon the exit of the ambulance from the scene of emergency. The impacts from call-outs on the genuine OHCA patients are approximated and the fire services called-out two-three times for every genuine OHCA cardiac arrest with potential benefit attached. Process developers and those at the realm of decision making must consider the impacts or the shortcomings before deciding on the hospital preferences and priorities.⁽²⁰⁾ This consideration must be based on the general understanding that the beneficiaries of the intervention are the OHCA male patient above the age of sixty years. Geographic factors influence the outcomes through the population density, and accidents particularly on roads.

Challenges of Economic Evaluation

The potential challenge in the economic evaluation of this intervention is with respect to the data collection methods, which show variations. It is critical to develop a common data definition as well as a universal taxonomy for research.⁽²¹⁾ The establishment of standard definition and the common taxonomy of the research will allow the effective comparison alongside the aggregation of data through various countries to improve the survival rates of OHCA patients. In addition to the variation of data collection methods, there is a challenge of accounting for the different system as well as demographic variables in the interpretation of the results in the variation of OHCA between the areas of study. The significance of undertaking a system-vast survey of the participating areas is essential in ensuring that the intervention particular population and structural variable are addressed.⁽²²⁾ This undertake is helpful to assist in the description of corresponding findings for the OHCA ensuring valid differences in comparisons.

Conclusion

The early defibrillation system through the utilization of the dual deliveries for the OHCA is economically efficient. From the cost-benefit analysis, the outcome points towards health benefits amounting to over 36 times the costs used. Similarly, the analysis of costs of utility classifies cost for every QALY as a means as well as the cost-effectiveness reflects the values or figures short of the set benchmark of the health standard.⁽²²⁾ These findings recommend a vast implementation of this defibrillation program within the same context to increase the chances of survival amongst the OHCA patients.

 

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