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Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

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dc.contributor.authorNor Zam Azihan Mohd Hassan
dc.contributor.authorMohd Shahri Bahari
dc.contributor.authorSivaraj Raman
dc.contributor.authorFarhana Aminuddin
dc.contributor.authorMohd Shaiful Jefri Mohd Nor Sham Kunusagaran
dc.contributor.authorNur Amalina Zaimi
dc.contributor.authorMin Fui Wong
dc.contributor.authorMarhaini Mostapha
dc.contributor.authorAhmad Tajuddin Mohamad Nor
dc.contributor.authorMohd Ridzwan Shahari
dc.date.accessioned2025-04-28T08:23:07Z
dc.date.available2025-04-28T08:23:07Z
dc.date.issued2024
dc.description.abstractBackground: Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). Methods: A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. Results Findings showed that the most expensive strategy, which is implementing 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost effectiveness of the replacement strategies. Conclusions: The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
dc.identifier.doi10.1186/s12913-024-10557-4
dc.identifier.urihttps://repository.nih.gov.my/handle/123456789/1608
dc.language.isoen_US
dc.relation.ispartofBMC Health Services Research
dc.relation.issn1472-6963
dc.relation.journalBMC Health Services Research
dc.subjectAmbulance
dc.subjectCost-effectiveness
dc.subjectAmbulance replacement strategy
dc.subjectEmergency
dc.subjectMarkov modelling
dc.titleModelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia
dc.typejournal-article
dspace.entity.typePublication
oaire.citation.issue1
oaire.citation.volume24
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