Abstract
The paper demonstrates how a system dynamics approach can support strategic planning of health care services and can in particular help to balance cost-effectiveness considerations with budget impact considerations when assessing a comprehensive package of stroke care interventions in Singapore. A population-level system dynamics model is used to investigate 12 intervention scenarios based on six stroke interventions (a public information campaign, thrombolysis, endovascular therapy, acute stroke unit (ASU), out-of-hospital rehabilitation, and secondary prevention). Primary outcomes included cumulative discounted costs and quality-adjusted life years (QALYs) gained, as well as cumulative net monetary benefit by 2030. All intervention scenarios result in an increase in net monetary benefit by 2030; much of these gains were realized through improved post-acute care. Findings highlight the importance of coordination of care, and affirms the economic value of current stroke interventions.
Keywords:
Acknowledgements
Preliminary work for this project was carried out by Ms. Yuan Tian whose contribution we appreciate. We thank Martin Kunc and Sally Brailsford for providing helpful comments on the draft of this article.
Disclosure statement
Dr. Koh owns equity in a private tele-rehabilitation company, T-Rehab Private Limited. The other authors report no conflicts.
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.