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Economic evaluations on centralisation of specialised healthcare services: a systematic review of methods

Lookup NU author(s): Dr Nawaraj BhattaraiORCiD, Dr Peter McMeekin, Professor Christopher PriceORCiD, Professor Luke ValeORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Objective To systematically review and appraise the quality of economic evaluations assessing centralisation of specialised healthcare services.Methods A systematic review to identify economic evaluations on centralisation of any specialised healthcare service. Full economic evaluations comparing costs and consequences of centralisation of any specialised healthcare service were eligible for inclusion. Methodological characteristics of included studies were appraised using checklists adapted from recommended guidelines.Results A total of 64 full-text articles met the inclusion criteria. Two studies were conducted in the UK. Most of the studies used volume of activity as a proxy measure of centralisation. The methods used to assess centralisation were heterogeneous. Studies differed in terms of study design used and aspect of centralisation they considered. There were major limitations in studies. Only 12 studies reported the study perspective. Charges which are not true representation of costs were used by 17 studies to assess cost outcomes. Only 10 reported the detailed breakdown of the cost components used in their analysis. Discounting was necessary in 14 studies but was reported only in 7 studies. Sensitivity analyses were included by less than one-third of the studies. The applicability of the identified studies to a setting other than the one they were conducted in is questionable, given variations in the organisation of services and healthcare costs. Centralisation as a concept has also been variably and narrowly defined as activity of specific services which may not reflect the wider aspects of centralisation.Conclusions Confounded and biased information coming from studies without standardised methods may mislead decision-makers towards making wrong decisions on centralisation. It is important to improve the methodology and reporting of economic evaluations in order to provide more robust and transferable evidence. Wider aspects of healthcare centralisation should be considered in the estimates of costs and health outcomes.

Publication metadata

Author(s): Bhattarai N, McMeekin P, Price C, Vale L

Publication type: Review

Publication status: Published

Journal: BMJ Open

Year: 2016

Volume: 6

Issue: 5

Online publication date: 06/05/2016

Acceptance date: 18/04/2015

ISSN (electronic): 2044-6055



DOI: 10.1136/bmjopen-2016-011214