1
|
Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
2
|
Cavazza M, Sartirana M, Wang Y, Falk M. Assessment of a SARS-CoV-2 population-wide rapid antigen testing in Italy: a modeling and economic analysis study. Eur J Public Health 2023; 33:937-943. [PMID: 37500599 PMCID: PMC10567128 DOI: 10.1093/eurpub/ckad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND This study aimed to compare the cost-effectiveness of coronavirus disease 2019 (COVID-19) mass testing, carried out in November 2020 in the Italian Bolzano/Südtirol province, to scenarios without mass testing in terms of hospitalizations averted and quality-adjusted life-year (QALYs) saved. METHODS We applied branching processes to estimate the effective reproduction number (Rt) and model scenarios with and without mass testing, assuming Rt = 0.9 and Rt = 0.95. We applied a bottom-up approach to estimate the costs of mass testing, with a mixture of bottom-up and top-down methodologies to estimate hospitalizations averted and incremental costs in case of non-intervention. Lastly, we estimated the incremental cost-effectiveness ratio (ICER), denoted by screening and related social costs, and hospitalization costs averted per outcome derived, hospitalizations averted and QALYs saved. RESULTS The ICERs per QALY were €24 249 under Rt = 0.9 and €4604 under Rt = 0.95, considering the official and estimated data on disease spread. The cost-effectiveness acceptability curves show that for the Rt = 0.9 scenario, at the maximum threshold willingness to pay the value of €40 000, mass testing has an 80% probability of being cost-effective compared to no mass testing. Under the worst scenario (Rt = 0.95), at the willingness to pay threshold, mass testing has an almost 100% probability of being cost-effective. CONCLUSIONS We provide evidence on the cost-effectiveness and potential impact of mass COVID-19 testing on a local healthcare system and community. Although the intervention is shown to be cost-effective, we believe the initiative should be carried out when there is initial rapid local disease transmission with a high Rt, as shown in our model.
Collapse
Affiliation(s)
- Marianna Cavazza
- Cergas (Centre for Research on Health and Social Care Management) - SDA Bocconi School of Management, Bocconi University, Milano, Italy
| | - Marco Sartirana
- Cergas (Centre for Research on Health and Social Care Management) - SDA Bocconi School of Management, Bocconi University, Milano, Italy
| | - Yuxi Wang
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milano, Italy
| | - Markus Falk
- EURAC Research, Bolzano, Autonome Provinz Bozen—Südtirol, Italy
| |
Collapse
|
3
|
Pachito DV, Etges APBDS, Oliveira PRBPD, Basso J, Bagattini ÂM, Riera R, Gehres LG, Mallmann ÉDB, Rodrigues ÁS, Gadenz SD. Micro-Costing of a Remotely Operated Referral Management System to Secondary Care in the Unified Health System in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2035-2043. [PMID: 35544829 DOI: 10.1590/1413-81232022275.07472021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.
Collapse
Affiliation(s)
- Daniela Vianna Pachito
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ana Paula Beck da Silva Etges
- Faculdade de Tecnologia, Pontifícia Universidade Católica do Rio Grande do Sul. Porto Alegre RS Brasil.,Instituto de Avaliação de Tecnologia em Saúde. Porto Alegre RS Brasil
| | | | - Josué Basso
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| | - Ângela Maria Bagattini
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês. São Paulo SP Brasil.,Escola Paulista de Medicina, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | | | - Sabrina Dalbosco Gadenz
- Regula Mais Brasil, Hospital Sírio-Libanês. R. Barata Ribeiro 142, Bela Vista. 01308-000 São Paulo Brasil.
| |
Collapse
|
4
|
Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: Providing a practical framework for surgeons. Int J Health Plann Manage 2022; 37:1926-1940. [PMID: 35191067 DOI: 10.1002/hpm.3431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/25/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.
Collapse
Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni C Athanasiadou
- Surgical Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Andreas I Tooulias
- First General Surgery Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
5
|
Factors affecting adult intensive care units costs by using the bottom-up and top-down costing methodology in OECD countries: A systematic review. Intensive Crit Care Nurs 2021; 66:103080. [PMID: 34059412 DOI: 10.1016/j.iccn.2021.103080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To review the studies, which calculated the total intensive care unit costs and indicated the main cost drivers in the intensive care by using either top-down, bottom-up approach or the combination of them. RESEARCH METHODOLOGY/DESIGNS A systematic review of papers published until October 2020 was conducted. Search was performed on PubMed, Medline, Scopus and Science Direct databases. SETTING This review i examined costs in adult intensive care units, in countries belonging to the Organisation for Economic Co-operation and Development (OECD) (medical, surgical or general adult , paediatric and neonatal were not included). MAIN OUTCOME MEASURES Eighteen articles were included in the review. RESULTS Eight of the studies used the top-down costing methodology, six of them used the bottom-up approach and four of them used both of them. The mean total patient cost per day ranged from €200.75 to €4321.91 (all costs are presented in 2020 values for euro). Human resources were identified as the largest proportion of total costs. Length of stay, mechanical ventilation, continuous haemodialysis and severe illness are the main cost drivers of intensive care unit total costs. CONCLUSION There are a variety of methods and study designs used to calculate costs of an intensive care unit stay.t It is necessary to evolve standardised costing methods in order to make comparisons and succeed in cost-effective management.
Collapse
|
6
|
Ricci de Araújo T, Papathanassoglou E, Gonçalves Menegueti M, Grespan Bonacim CA, Lessa do Valle Dallora ME, de Carvalho Jericó M, Basile-Filho A, Laus AM. Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil. J Nurs Manag 2021; 29:1778-1784. [PMID: 33772914 DOI: 10.1111/jonm.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND Accurate data of nursing cost can contribute to reliable resource management. METHOD We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
Collapse
Affiliation(s)
- Thamiris Ricci de Araújo
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Mayra Gonçalves Menegueti
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Anibal Basile-Filho
- Department of Surgery and Anatomy of Medical School, Division of Intensive Medicine of Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Laus
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
7
|
Xu X, Lazar CM, Ruger JP. Micro-costing in health and medicine: a critical appraisal. HEALTH ECONOMICS REVIEW 2021; 11:1. [PMID: 33404857 PMCID: PMC7789519 DOI: 10.1186/s13561-020-00298-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/30/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Concerns about rising health care costs require rigorous economic study to inform clinical and policy decision-making. Micro-costing is a cost estimation methodology employing detailed resource utilization and unit cost data to generate precise estimates of economic costs. Micro-costing studies have not been critically appraised. METHODS Critical appraisal of micro-costing studies in English. Studies fully or predominantly employing micro-costing were appraised for methodological and reporting quality through economic evaluation guidelines (Evers, Drummond, Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Fukuda and Imanaka checklists). Following the Panel on Cost Effectiveness in Health and Medicine, micro-costing studies were defined as involving "direct enumeration and costing out of every input consumed in the treatment of a particular patient." RESULTS Full or predominant micro-costing studies included neoplasms (18.5%), infectious and parasitic diseases (17.9%), and diseases of circulatory systems (10.8%) as the most studied diseases. 36.9% were in the United States and 34.9% were in Europe. 33.8% did not report analytic perspective, 32.8% did not report price year, 3.6% did not inflation adjust cost data, and 44.1% did not specify inflation adjustment. 86.2% did not separately report unit costs and resource utilization quantity, 14.9 and 19.5% did not provide sufficient detail to assess appropriateness of measured physical units or valued costs. CONCLUSIONS Micro-costing studies vary widely in methodological and reporting quality, highlighting the need to standardize methods and reporting of micro-costing studies and develop tools for their evaluation.
Collapse
Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, USA
| | - Christina M Lazar
- Department of Psychiatry, VA Connecticut Healthcare System, Yale School of Medicine, New Haven, USA
| | - Jennifer Prah Ruger
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, The Leonard Davis Institute of Health Economics, School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA.
| |
Collapse
|
8
|
O'Mahony C, Murphy KD, O'Brien GL, Aherne J, Hanan T, Mullen L, Keane M, Donnellan P, Davey C, Browne H, Malee K, Byrne S. A cost comparison study to review community versus acute hospital models of nursing care delivered to oncology patients. Eur J Oncol Nurs 2020; 49:101842. [PMID: 33126156 DOI: 10.1016/j.ejon.2020.101842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Ireland's Sláintecare health plan is placing an increased focus on primary care. A community oncology nursing programme was developed to train community nurses to deliver care in the community. While the initial pilot was proven to be clinically safe, no cost evaluation was carried out. This study aims to compare the costs of providing cancer support services in a day-ward versus in the community. METHODS 183 interventions (40 in day-ward and 143 in community) were timed and costed using healthcare professional salaries and the Human Capital method. RESULTS From the healthcare provider perspective, the day-ward was a significantly cheaper option by an average of €17.13 (95% CI €13.72 - €20.54, p < 0.001). From the societal perspective, the community option was cheaper by an average of €2.77 (95% CI -€3.02 - €8.55), although this was a non-significant finding. Sensitivity analyses indicate that the community service may be significantly cheaper from the societal perspective. CONCLUSIONS Given the demand for cost-viable options for primary care services, this programme may represent a national option for cancer care in Ireland when viewed from the societal perspective.
Collapse
Affiliation(s)
- Cian O'Mahony
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland.
| | - Kevin D Murphy
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Gary L O'Brien
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| | - Joe Aherne
- Leading Edge Group, Charter House, Harbour Row, Kilgarvan, Cobh, Cork, Ireland
| | - Terry Hanan
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin 1, Ireland
| | - Louise Mullen
- National Cancer Control Programme, Kings Inns House, 200 Parnell St, Dublin 1, Ireland
| | - Maccon Keane
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Paul Donnellan
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Claire Davey
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Helen Browne
- Community Healthcare West, Health Centre, Inis Meain, Aran Islands, Co Galway, Ireland
| | - Kathleen Malee
- Department of Public Health Nursing, University Hospital Galway, Galway, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Group, School of Pharmacy, University College Cork, College Road, Cork, Ireland
| |
Collapse
|
9
|
Madan JJ, Rosu L, Tefera MG, van Rensburg C, Evans D, Langley I, Tomeny EM, Nunn A, Phillips PP, Rusen ID, Squire SB. Economic evaluation of short treatment for multidrug-resistant tuberculosis, Ethiopia and South Africa: the STREAM trial. Bull World Health Organ 2020; 98:306-314. [PMID: 32514196 PMCID: PMC7265936 DOI: 10.2471/blt.19.243584] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis. Methods We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up and top-down approaches. A cost–effectiveness analysis was performed by calculating the incremental cost per unfavourable outcome avoided. Findings Health-care costs per participant in South Africa were 8340.7 United States dollars (US$) with the long and US$ 6618.0 with the short regimen; in Ethiopia, they were US$ 6096.6 and US$ 4552.3, respectively. The largest component of the saving was medication costs in South Africa (67%; US$ 1157.0 of total US$ 1722.8) and social support costs in Ethiopia (35%, US$ 545.2 of total US$ 1544.3). In Ethiopia, trial participants on the short regimen reported lower expenditure for supplementary food (mean reduction per participant: US$ 225.5) and increased working hours (i.e. 667 additional hours over 132 weeks). The probability that the short regimen was cost–effective was greater than 95% when the value placed on avoiding an unfavourable outcome was less than US$ 19 000 in Ethiopia and less than US$ 14 500 in South Africa. Conclusion The short MDR tuberculosis treatment regimen was associated with a substantial reduction in health-system costs and a lower financial burden for participants.
Collapse
Affiliation(s)
- Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, England
| | - Laura Rosu
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Mamo Girma Tefera
- Department of Business Management, Addis Ababa Science & Technology University, Addis Ababa, Ethiopia
| | - Craig van Rensburg
- Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa
| | - Ivor Langley
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Ewan M Tomeny
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | - Andrew Nunn
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, London, England
| | - Patrick Pj Phillips
- Department of Medicine, University of California San Francisco, San Francisco, United States of America (USA)
| | - I D Rusen
- Division of Research and Development, Vital Strategies, New York, USA
| | - S Bertel Squire
- Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, England
| | | |
Collapse
|
10
|
Doble B, Welbourn R, Carter N, Byrne J, Rogers CA, Blazeby JM, Wordsworth S. Multi-Centre Micro-Costing of Roux-En-Y Gastric Bypass, Sleeve Gastrectomy and Adjustable Gastric Banding Procedures for the Treatment of Severe, Complex Obesity. Obes Surg 2020; 29:474-484. [PMID: 30368646 DOI: 10.1007/s11695-018-3553-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom. METHODS Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients' first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs. RESULTS Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4-6%). Reducing prices of consumables by 20% reduced costs by 10-13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7-10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982). CONCLUSIONS These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required.
Collapse
Affiliation(s)
- Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Nicholas Carter
- Bariatric and Metabolic Surgery Department, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK
| | - James Byrne
- Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Medical School, University of Bristol, Bristol, BS2 8HW, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| |
Collapse
|
11
|
Defourny N, Monten C, Grau C, Lievens Y, Perrier L. Critical review and quality-assessment of cost analyses in radiotherapy: How reliable are the data? Radiother Oncol 2019; 141:14-26. [PMID: 31630866 DOI: 10.1016/j.radonc.2019.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE/OBJECTIVE Health economic evaluations (HEE) are increasingly having an impact on policymakers, although the results greatly depend on the quality of the methodology used and on transparent reporting. The two main objectives of this study were to evaluate the quality of cost analyses of external beam radiotherapy (EBRT) and to assess the comprehensiveness and relevance of cost criteria defined in three validated quality-assessment instruments. MATERIALS AND METHODS The selection of articles was based on a previous systematic literature review of EBRT-costing studies retrieved from January 2004 to January 2015 (Period 1) in MEDLINE, Embase, and NHS-EED databases and completed in a second time period from January 2015 to November 2018 (Period 2). Three validated instruments to assess the methodology quality with the CHEC and the QHES, and the methodology with the CHEERS checklists were used. The quality was evaluated by both quantitative and qualitative analyses. The scoring robustness was examined with the Kendall coefficient of concordance and inter-class correlation coefficients. RESULTS In total, twenty-three articles were selected. The main geographic areas of cost analyses were Canada (n = 5), France (n = 4), and the USA (n = 4). The most commonly studied pathologies and technologies were prostate (n = 7) and head and neck cancer (n = 5) and IMRT (n = 8) and IGRT (n = 2), respectively. The mean instrument scores demonstrated a fair degree of methodological quality, with 69.7% for the CHEC, 73.6% for the QHES, as well as for the reporting quality, with 59.4% for CHEERS for Period 1 (74.4%, 71.5%, and 66.1%, respectively, for Period 2). An additional qualitative analysis per criterion revealed that certain items, essential for understanding the costing methodology and the results (e.g., the time horizon, discount rate, sensitivity analysis) were often only partially completed. Statistical analysis confirmed that the reviewers' scoring was consistent. The instruments identified the same top three articles, albeit with a degree of variation in the ranking. CONCLUSION Qualitative and quantitative assessment of cost analyses in EBRT exhibits a fair level of study quality in terms of the methodology and reporting transparency. The impact of cost calculations on the final HEE result appears to be underestimated, and increased transparency of the data sources and the methodologies is needed.
Collapse
Affiliation(s)
- Noémie Defourny
- Ghent University, European SocieTy for Radiotherapy & Oncology, Brussels, Belgium.
| | - Chris Monten
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium
| | - Cai Grau
- Aarhus University Hospital, Aarhus C, Denmark
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Belgium
| | - Lionel Perrier
- Université de Lyon, Léon Bérard Cancer Centre, GATE UMR 5824, Lyon, France
| |
Collapse
|
12
|
Cyganska M, Cyganski P, Pyke C. Development of clinical value unit method for calculating patient costs. HEALTH ECONOMICS 2019; 28:971-983. [PMID: 31155799 DOI: 10.1002/hec.3902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 05/04/2019] [Accepted: 05/11/2019] [Indexed: 06/09/2023]
Abstract
The objective of the study was to develop the clinical value unit method of allocating indirect costs to patient costs using clinical factors. The method was tested to determine whether it is a more reliable alternative to using the length of stay and marginal mark-up allocation method. The method developed used data from a Polish specialist hospital. The study involved 4,026 patients grouped into nine diagnosis-related groups (DRG). The study methodology involved a three stage approach: (a) identification of correlates of patient costs, (b) a comparison of the costs calculated using the clinical value unit method with the alternative methods: length of stay and marginal mark-up methods, and (c) an estimation of the cost homogeneity of the DRGs. The study showed that length of stay cost allocation method may underestimate the proportion of indirect costs in patient costs for a short in-patient stay and overestimate the cost for the patients with a long stay. The total costs estimated using the marginal mark-up method were higher than those estimated with length of stay method. For most surgical procedures, the mean indirect costs are higher using clinical value unit method than when using length of stay or marginal mark-up method. In all medical procedure cases, the mean indirect costs calculated using the clinical value unit method are in the range between marginal mark-up and length of stay method. We also show that in all DRGs except one, that the coefficient of homogeneity for clinical value unit is higher than for length of stay or marginal mark-up method. We conclude that the clinical value unit method of cost allocation is a more precise and reliable alternative than the other methods.
Collapse
Affiliation(s)
- Malgorzata Cyganska
- Faculty of Economics, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Piotr Cyganski
- Faculty of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Chris Pyke
- Lancashire School of Business and Enterprise, University of Central Lancashire, Preston, UK
| |
Collapse
|
13
|
Charvin M, Späth HM, Bernard A, Bertaux AC. A micro-costing evaluation of lobectomy by thoracotomy versus thoracoscopy. J Thorac Dis 2019; 11:1233-1242. [PMID: 31179065 DOI: 10.21037/jtd.2019.03.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Two surgical strategies called video-assisted thoracoscopy surgery (VATS) and thoracotomy are used for lobectomy following lung cancer diagnosis. The aim of this study was to assess the total cost of each technique (thoracotomy and VATS) during hospitalization in France. Methods A micro-costing methodology from the hospital perspective was implemented to assess the hospitalization costs, using direct observations, interviews, and data collection based on medical records in four hospitals. The average real cost of each technique was compared. Results From the hospital perspective, VATS was more expensive than thoracotomy but the difference was not significant (€6,941.30 vs. €5,950.11). Conclusions According to this micro-costing study, thoracotomy seems to be the less expensive technique for the hospital. Our data will be included in a cost-utility analysis to assess the medico-economic impact of the VATS strategy.
Collapse
Affiliation(s)
- Maud Charvin
- Department of Health Economy, CHU Dijon, Dijon, France
| | - Hans Martin Späth
- EA 4129 P2S Parcours Santé Systémique, University Claude Bernard Lyon 1, University Lyon 1, Lyon, France
| | - Alain Bernard
- Department of Thoracic and Cardiovascular Surgery, CHU Dijon, Dijon, France
| | | |
Collapse
|
14
|
O'Brien GL, O'Mahony C, Cooke K, Kinneally A, Sinnott SJ, Walshe V, Mulcahy M, Byrne S. Cost Minimization Analysis of Intravenous or Subcutaneous Trastuzumab Treatment in Patients With HER2-Positive Breast Cancer in Ireland. Clin Breast Cancer 2019; 19:e440-e451. [PMID: 30853347 DOI: 10.1016/j.clbc.2019.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/10/2019] [Accepted: 01/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Two large acute Irish University teaching hospitals changed the manner in which they treated human epidermal growth factor receptor (HER)2-positive breast cancer patients by implementing the administration of trastuzumab via the subcutaneous (SC) route into their clinical practice. The study objective is to compare the trastuzumab SC and trastuzuamb intravenous (IV) treatment pathways in both hospitals and assess which route is more cost-effective and time saving in relation to active health care professional (HCP) time. MATERIALS AND METHODS A prospective observational study in the form of cost minimization analysis constituted the study design. Active HCP time for trastuzumab SC- and IV-related tasks were recorded. Staff costs were calculated using fully loaded salary costs. Loss of productivity costs for patients were calculated using the human capital method. RESULTS On average, the total HCP time saved per trastuzumab SC treatment cycle relative to trastuzumab IV treatment cycle was 59.21 minutes. Time savings in favor of trastuzumab SC resulted from quicker drug reconstitution, no IV catheter installation/removal, and less HCP monitoring. Over a full treatment course of 17 cycles, average HCP time saved accumulates to 16.78 hours, with an estimated direct cost saving of €1609.99. Loss of productivity for patients receiving trastuzumab IV (2.15 days) was greater than that of trastuzumab SC (0.60 days) for a full treatment course. CONCLUSION Trastuzumab SC treatment has proven to be a more cost-effective option than trastuzumab IV treatment that generated greater HCP time savings in both study sites. Healthcare policymakers should consider replacing trastuzumab IV with trastuzumab SC treatment in all eligible patients.
Collapse
Affiliation(s)
- Gary L O'Brien
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Cian O'Mahony
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Katie Cooke
- Pharmacy Department, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Ada Kinneally
- Oncology Department, University Hospital Waterford, Waterford, Ireland
| | - Sarah-Jo Sinnott
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Valerie Walshe
- National Finance Division, Health Service Executive, Model Business Park, Cork, Ireland
| | - Mark Mulcahy
- Department of Accounting, Finance and Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| |
Collapse
|
15
|
National cost study versus hospital cost accounting for organ recovery cost assessment in a French hospital group. Cost Eff Resour Alloc 2018; 16:34. [PMID: 30356786 PMCID: PMC6190563 DOI: 10.1186/s12962-018-0155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
|
16
|
Challenges of Costing a Surgical Procedure in a Lower-Middle-Income Country. World J Surg 2018; 43:52-59. [PMID: 30128774 DOI: 10.1007/s00268-018-4773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower-middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHODS A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities. RESULTS The total cost [(interquartile range), number] of TAH was USD 339 [(308-397), n = 24] versus USD 338 [(312-422), n = 25], NDVH was USD 315 [(316-541), n = 23] versus USD 357 [(282-739), n = 26] and TLH was USD 393 [(338-446), n = 24] versus USD 429 [(390-504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy. CONCLUSIONS The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings. TRIAL REGISTRATION The study was registered in the Sri Lanka clinical trials registry (SLCTR/2016/020) and the International Clinical Trials Registry Platform (U1111-1194-8422) on 26 July 2016.
Collapse
|
17
|
Stenberg K, Lauer JA, Gkountouras G, Fitzpatrick C, Stanciole A. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:11. [PMID: 29559855 PMCID: PMC5858135 DOI: 10.1186/s12962-018-0095-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/28/2018] [Indexed: 12/30/2022] Open
Abstract
Background Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Methods Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. Results Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. Conclusions These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.
Collapse
Affiliation(s)
- Karin Stenberg
- 1Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Jeremy A Lauer
- 1Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | | | - Anderson Stanciole
- United Nations Population Fund, Asia and Pacific Regional Office, Bangkok, Thailand
| |
Collapse
|
18
|
Stokes EA, Wordsworth S, Staves J, Mundy N, Skelly J, Radford K, Stanworth SJ. Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service. Transfusion 2018; 58:846-853. [DOI: 10.1111/trf.14493] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Elizabeth A. Stokes
- Health Economics Research Centre, Nuffield Department of Population Health; University of Oxford
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health; University of Oxford
| | - Julie Staves
- Transfusion Laboratory, Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Nicola Mundy
- Department of Blood Sciences; Royal Berkshire NHS Foundation Trust; Reading UK
| | - Jane Skelly
- Haematology Day Unit, Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Kelly Radford
- Oncology and Haematology Clinical Trials; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Simon J. Stanworth
- Transfusion Medicine; NHS Blood and Transplant; Oxford
- Department of Haematology; Oxford University Hospitals NHS Foundation Trust; Oxford UK
- Radcliffe Department of Medicine; University of Oxford, and the Haematology Theme, Oxford Biomedical Research Centre; Oxford UK
| |
Collapse
|
19
|
Stafyla E, Geitona M, Kerenidi T, Economou A, Daniil Z, Gourgoulianis KI. The annual direct costs of stable COPD in Greece. Int J Chron Obstruct Pulmon Dis 2018; 13:309-315. [PMID: 29398912 PMCID: PMC5774741 DOI: 10.2147/copd.s148051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) places a major burden on health care systems and has substantial economic effects; however, the cost of stable disease in Greece has never been thoroughly explored. The objective of the study was to estimate the annual COPD patient cost during the maintenance phase and explore the relationships between the cost and disease severity. Methods Data were collected from 245 COPD patients (male: 231, mean age: 69.5±8.8 years) who visited the outpatient unit of University Hospital of Larissa in 2014 and 2015. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, and the patients’ direct cost during the maintenance phase was calculated. Results Eleven percent of COPD patients were stage I, 48.2% were stage II, 29% were stage III, and 11.8% were stage IV. According to the GOLD groups, 23.3% of patients were grade A, 15.5% were grade B, 22.9% were grade C, and 38.4% were grade D. The mean annual direct cost for stable disease was estimated at €1,034.55 per patient, of which €222.94 corresponded to out-of-pocket payments. The annual cost ranged from €408.23 to €2,041.89 depending on GOLD stages (I–IV) and from €550.01 to €1,480.00 depending on GOLD groups (A–D). The key cost driver was pharmaceutical treatment, which reflected almost 71% of the total expenses for the management of stable disease. The mean annual per-patient cost was two to three times higher for those with advanced disease (stages III–IV) compared to those with stages I–II disease, and it doubled for “high-risk” patients (groups C–D) compared to “low-risk” patients (groups A–B). Conclusion The cost of COPD during the maintenance phase is remarkable, with the key cost driver found to be pharmaceutical treatment and social insurance funds the key payer for treating COPD patients in Greece. The cost of stable disease is proportional to the severity of COPD, and it is doubled in patients who belong to high-risk groups.
Collapse
Affiliation(s)
- Eirini Stafyla
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa
| | - Mary Geitona
- School of Social Sciences, University of Peloponnese, Corinth
| | - Theodora Kerenidi
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa
| | - Athina Economou
- Department of Economics, University of Thessaly, Volos, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa
| | - Konstantinos I Gourgoulianis
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa
| |
Collapse
|
20
|
Hassard J, Teoh KR, Visockaite G, Dewe P, Cox T. The financial burden of psychosocial workplace aggression: A systematic review of cost-of-illness studies. WORK AND STRESS 2017. [DOI: 10.1080/02678373.2017.1380726] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Juliet Hassard
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Kevin R.H. Teoh
- The Centre for Sustainable Working Life, Birkbeck University of London, Clore Management Centre, London, UK
- The Department of Organizational Psychology, Birkbeck University of London, Clore Management Centre, London, UK
| | - Gintare Visockaite
- The Department of Organizational Psychology, Birkbeck University of London, Clore Management Centre, London, UK
| | - Philip Dewe
- The Centre for Sustainable Working Life, Birkbeck University of London, Clore Management Centre, London, UK
| | - Tom Cox
- The Centre for Sustainable Working Life, Birkbeck University of London, Clore Management Centre, London, UK
| |
Collapse
|
21
|
Nunes SEA, Minamisava R, Vieira MADS, Itria A, Pessoa VP, Andrade ALSSD, Toscano CM. Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods. EINSTEIN-SAO PAULO 2017; 15:212-219. [PMID: 28767921 PMCID: PMC5609619 DOI: 10.1590/s1679-45082017gs3855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/07/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Methods Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Results Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006). Conclusion Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children.
Collapse
Affiliation(s)
- Sheila Elke Araujo Nunes
- Universidade Estadual da Região Tocantina do Maranhão, Imperatriz, MA, Brazil.,Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | | | | | | | | | | |
Collapse
|
22
|
Costa S, Regier DA, Meissner B, Cromwell I, Ben-Neriah S, Chavez E, Hung S, Steidl C, Scott DW, Marra MA, Peacock SJ, Connors JM. A time-and-motion approach to micro-costing of high-throughput genomic assays. ACTA ACUST UNITED AC 2016; 23:304-313. [PMID: 27803594 DOI: 10.3747/co.23.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes-digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis-in the context of lymphoma patient management. METHODS The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. RESULTS The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. CONCLUSIONS With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice.
Collapse
Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - B Meissner
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - I Cromwell
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC
| | - S Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - E Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - S Hung
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| | - M A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medical Genetics, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC; Department of Cancer Control Research, BC Cancer Agency, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - J M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, University of British Columbia, Vancouver, BC; Department of Medicine, University of British Columbia, Vancouver, BC
| |
Collapse
|
23
|
Ruger JP, Reiff M. A Checklist for the Conduct, Reporting, and Appraisal of Microcosting Studies in Health Care: Protocol Development. JMIR Res Protoc 2016; 5:e195. [PMID: 27707687 PMCID: PMC5071616 DOI: 10.2196/resprot.6263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022] Open
Abstract
Background Microcosting is a cost estimation method that requires the collection of detailed data on resources utilized, and the unit costs of those resources in order to identify actual resource use and economic costs. Microcosting findings reflect the true costs to health care systems and to society, and are able to provide transparent and consistent estimates. Many economic evaluations in health and medicine use charges, prices, or payments as a proxy for cost. However, using charges, prices, or payments rather than the true costs of resources can result in inaccurate estimates. There is currently no existing checklist or guideline for the conduct, reporting, or appraisal of microcosting studies in health care interventions. Objective The aim of this study is to create a checklist and guideline for the conduct, reporting, and appraisal of microcosting studies in health care interventions. Methods Appropriate potential domains and items will be identified through (1) a systematic review of all published microcosting studies of health and medical interventions, strategies, and programs; (2) review of published checklists and guidelines for economic evaluations of health interventions, and selection of items relevant for microcosting studies; and (3) theoretical analysis of economic concepts relevant for microcosting. Item selection, formulation, and reduction will be conducted by the research team in order to develop an initial pool of items for evaluation by an expert panel comprising individuals with expertise in microcosting and economic evaluation of health interventions. A modified Delphi process will be conducted to achieve consensus on the checklist. A pilot test will be conducted on a selection of the articles selected for the previous systematic review of published microcosting studies. Results The project is currently in progress. Conclusions Standardization of the methods used to conduct, report or appraise microcosting studies will enhance the consistency, transparency, and comparability of future microcosting studies. This will be the first checklist for microcosting studies to accomplish these goals and will be a timely and important contribution to the health economic and health policy literature. In addition to its usefulness to health economists and researchers, it will also benefit journal editors and decision-makers who require accurate cost estimates to deliver health care.
Collapse
Affiliation(s)
- Jennifer Prah Ruger
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, United States.
| | | |
Collapse
|
24
|
Spencer Netto F, Quereshy F, Camilotti BG, Pitzul K, Kwong J, Jackson T, Penner T, Okrainec A. Hospital costs associated with laparoscopic and open inguinal herniorrhaphy. JSLS 2016; 18:JSLS.2014.00217. [PMID: 25392677 PMCID: PMC4216173 DOI: 10.4293/jsls.2014.00217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. METHODS A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operating room (OR) and total hospital costs. RESULTS Two hundred eleven patients underwent elective unilateral inguinal herniorrhaphy (117 open and 94 laparoscopic), and 33 patients underwent elective bilateral inguinal herniorrhaphy (9 open and 24 laparoscopic). OR and total hospital costs for open unilateral inguinal hernia repair were significantly lower than for the laparoscopic approach (median total cost, $3207.15 vs $3723.66; P < .001). OR and total hospital costs for repair of elective bilateral inguinal hernias were similar between the open and laparoscopic approaches (median total cost, $4574.02 vs $4662.89; P = .827). CONCLUSIONS In the setting of a Canadian academic hospital, when considering the repair of an elective unilateral inguinal hernia, the OR and total hospital costs of open surgery were significantly lower than for the laparoscopic techniques. There was no statistical difference between OR and total hospital costs when comparing open surgery and laparoscopic techniques for the repair of bilateral inguinal hernias. Given the perioperative benefits of laparoscopy, further studies incorporating hernia-specific outcomes are necessary to determine the cost-effectiveness of each approach and to define the optimal treatment strategy.
Collapse
Affiliation(s)
| | - Fayez Quereshy
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | | | - Kristen Pitzul
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Josephine Kwong
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Timothy Jackson
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Todd Penner
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Cunnama L, Sinanovic E, Ramma L, Foster N, Berrie L, Stevens W, Molapo S, Marokane P, McCarthy K, Churchyard G, Vassall A. Using Top-down and Bottom-up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale. HEALTH ECONOMICS 2016; 25 Suppl 1:53-66. [PMID: 26763594 PMCID: PMC5066665 DOI: 10.1002/hec.3295] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 10/27/2015] [Accepted: 11/05/2015] [Indexed: 05/06/2023]
Abstract
PURPOSE Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. MATERIALS AND METHODS We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. RESULTS The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. CONCLUSION Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.
Collapse
Affiliation(s)
- Lucy Cunnama
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edina Sinanovic
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lebogang Ramma
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicola Foster
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Leigh Berrie
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Wendy Stevens
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Sebaka Molapo
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | - Puleng Marokane
- National Priority Programmes, National Health Laboratory Services, Johannesburg, South Africa
| | | | - Gavin Churchyard
- Aurum Institute for Health Research, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna Vassall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
26
|
Packierisamy PR, Ng CW, Dahlui M, Inbaraj J, Balan VK, Halasa YA, Shepard DS. Cost of Dengue Vector Control Activities in Malaysia. Am J Trop Med Hyg 2015; 93:1020-1027. [PMID: 26416116 PMCID: PMC4703248 DOI: 10.4269/ajtmh.14-0667] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 08/20/2015] [Indexed: 02/04/2023] Open
Abstract
Dengue fever, an arbovirus disease transmitted by Aedes mosquitoes, has recently spread rapidly, especially in the tropical countries of the Americas and Asia-Pacific regions. It is endemic in Malaysia, with an annual average of 37,937 reported dengue cases from 2007 to 2012. This study measured the overall economic impact of dengue in Malaysia, and estimated the costs of dengue prevention. In 2010, Malaysia spent US$73.5 million or 0.03% of the country's GDP on its National Dengue Vector Control Program. This spending represented US$1,591 per reported dengue case and US$2.68 per capita population. Most (92.2%) of this spending occurred in districts, primarily for fogging. A previous paper estimated the annual cost of dengue illness in the country at US$102.2 million. Thus, the inclusion of preventive activities increases the substantial estimated cost of dengue to US$175.7 million, or 72% above illness costs alone. If innovative technologies for dengue vector control prove efficacious, and a dengue vaccine was introduced, substantial existing spending could be rechanneled to fund them.
Collapse
Affiliation(s)
| | - Chiu-Wan Ng
- *Address correspondence to Chiu-Wan Ng, Julius Centre for Clinical Epidemiology and Evidence-Based Medicine, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia. E-mail:
| | | | | | | | | | | |
Collapse
|
27
|
Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan. Malar J 2015; 14:217. [PMID: 26016871 PMCID: PMC4450447 DOI: 10.1186/s12936-015-0696-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/07/2015] [Indexed: 11/27/2022] Open
Abstract
Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria. Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER). Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy. Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision. Trial Registration The trial was registered at ClinicalTrials.gov under identifier NCT00935688. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0696-1) contains supplementary material, which is available to authorized users.
Collapse
|
28
|
Brennan A, Jackson A, Horgan M, Bergin CJ, Browne JP. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study. BMC Health Serv Res 2015; 15:139. [PMID: 25884351 PMCID: PMC4393598 DOI: 10.1186/s12913-015-0816-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. Methods A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Ireland. The costs of individual appointment types were estimated based on staff grade and time. Hospital resources used by HIV patients who attended the ambulatory care service in 2012 were identified and extracted from existing hospital systems. Associations between patient characteristics and costs per patient month, in 2012 euros, were examined using univariate and multivariate analyses. Results The average cost of providing ambulatory HIV care was found to be €973 (95% confidence interval €938 - €1008) per patient month in 2012. Sensitivity analysis, varying the base-case staff time estimates by 20% and diagnostic testing costs by 60%, estimated the average cost to vary from a low of €927 per patient month to a high of €1019 per patient month. The vast majority of costs were due to the cost of HAART. Women were found to have significantly higher HAART costs per patient month while patients over 50 years of age had significantly lower HAART costs using multivariate analysis. Conclusions This study provides the estimated cost of ambulatory care in a regional HIV centre in Ireland. These data are valuable for planning services at a local level, and the identification of patient factors, such as age and gender, associated with resource use is of interest both nationally and internationally for the long-term planning of HIV care provision.
Collapse
Affiliation(s)
- Aline Brennan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - Arthur Jackson
- Cork University Hospital and Mercy University Hospital Cork, Cork, Ireland.
| | - Mary Horgan
- School of Medicine, University College Cork and Cork University Hospital, Cork, Ireland.
| | - Colm J Bergin
- St James's Hospital, Dublin and Trinity College Dublin, Dublin, Ireland.
| | - John P Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| |
Collapse
|
29
|
Balink H, Tan SS, Veeger NJGM, Holleman F, van Eck-Smit BLF, Bennink RJ, Verberne HJ. ¹⁸F-FDG PET/CT in inflammation of unknown origin: a cost-effectiveness pilot-study. Eur J Nucl Med Mol Imaging 2015; 42:1408-13. [PMID: 25655485 DOI: 10.1007/s00259-015-3010-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients with increased inflammatory parameters, nonspecific signs and symptoms without fever and without a diagnosis after a variety of diagnostic procedures are a diagnostic dilemma and are referred to as having inflammation of unknown origin (IUO). The objective of this pilot study was to compare the cost-effectiveness of a diagnostic work-up/strategy with and without (18)F-FDG PET/CT in patients with IUO using a published dataset as a reference. METHODS IUO patients without (18)F-FDG PET/CT (group A, 46 patients) and IUO patients referred for (18)F-FDG PET/CT (group B, 46 patients) were selected. IUO was defined as the combination of nonspecific signs and symptoms and a prolonged erythrocyte sedimentation rate (ESR), defined as ≥age/2 in men and ≥(age + 10)/2 in women (ESR in millimetres per hour and age in years), and/or C-reactive protein (CRP) ≥15 mg/l. The costs of all tests and procedures and the number of hospitalization days in each patient to reach a diagnosis were calculated using current Dutch tariffs. RESULTS In group A a diagnosis was reached in 14 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>2,051, and including the cost of hospitalization was <euro>12,614. In group B a diagnosis was reached in 32 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>1,821, significantly lower than in group A (p < 0.0002), and including the cost of hospitalization was <euro>5,298. CONCLUSION In IUO (18)F-FDG PET/CT has the potential to become a cost-effective routine imaging technique indicating the direction for further diagnostic decisions thereby allowing unnecessary, invasive and expensive diagnostic investigations to be avoided and possibly the duration of hospitalization to be reduced. However, a prospective multicentre "bottom-up microcosting" cost-effectiveness study is warranted before these preliminary data can be extrapolated to clinical practice.
Collapse
Affiliation(s)
- H Balink
- Department of Nuclear Medicine, Medical Center Leeuwarden, P.O. Box 850, 8901 BR, Leeuwarden, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
30
|
Raulinajtys-Grzybek M. Cost accounting models used for price-setting of health services: An international review. Health Policy 2014; 118:341-53. [DOI: 10.1016/j.healthpol.2014.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
|
31
|
Sach TH, Desborough J, Houghton J, Holland R. Applying micro-costing methods to estimate the costs of pharmacy interventions: an illustration using multi-professional clinical medication reviews in care homes for older people. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:237-247. [PMID: 25377218 DOI: 10.1111/ijpp.12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Economic methods are underutilised within pharmacy research resulting in a lack of quality evidence to support funding decisions for pharmacy interventions. The aim of this study is to illustrate the methods of micro-costing within the pharmacy context in order to raise awareness and use of this approach in pharmacy research. METHODS Micro-costing methods are particularly useful where a new service or intervention is being evaluated and for which no previous estimates of the costs of providing the service exist. This paper describes the rationale for undertaking a micro-costing study before detailing and illustrating the process involved. The illustration relates to a recently completed trial of multi-professional medication reviews as an intervention provided in care homes. All costs are presented in UK£2012. KEY FINDINGS In general, costing methods involve three broad steps (identification, measurement and valuation); when using micro-costing, closer attention to detail is required within all three stages of this process. The mean (standard deviation; 95% confidence interval (CI) ) cost per resident of the multi-professional medication review intervention was £104.80 (50.91; 98.72 to 109.45), such that the overall cost of providing the intervention to all intervention home residents was £36,221.29 (95% CI, 32 810.81 to 39 631.77). CONCLUSIONS This study has demonstrated that micro-costing can be a useful method, not only for estimating the cost of a pharmacy intervention to feed into a pharmacy economic evaluation, but also as a source of information to help inform those designing pharmacy services about the potential time and costs involved in delivering such services.
Collapse
Affiliation(s)
- Tracey H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Julie Houghton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Holland
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | |
Collapse
|
32
|
Mercier G, Naro G. Costing hospital surgery services: the method matters. PLoS One 2014; 9:e97290. [PMID: 24817167 PMCID: PMC4016301 DOI: 10.1371/journal.pone.0097290] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 04/18/2014] [Indexed: 11/19/2022] Open
Abstract
Background Accurate hospital costs are required for policy-makers, hospital managers and clinicians to improve efficiency and transparency. However, different methods are used to allocate direct costs, and their agreement is poorly understood. The aim of this study was to assess the agreement between bottom-up and top-down unit costs of a large sample of surgical operations in a French tertiary centre. Methods Two thousand one hundred and thirty consecutive procedures performed between January and October 2010 were analysed. Top-down costs were based on pre-determined weights, while bottom-up costs were calculated through an activity-based costing (ABC) model. The agreement was assessed using correlation coefficients and the Bland and Altman method. Variables associated with the difference between methods were identified with bivariate and multivariate linear regressions. Results The correlation coefficient amounted to 0.73 (95%CI: 0.72; 0.76). The overall agreement between methods was poor. In a multivariate analysis, the cost difference was independently associated with age (Beta = −2.4; p = 0.02), ASA score (Beta = 76.3; p<0.001), RCI (Beta = 5.5; p<0.001), staffing level (Beta = 437.0; p<0.001) and intervention duration (Beta = −10.5; p<0.001). Conclusions The ability of the current method to provide relevant information to managers, clinicians and payers is questionable. As in other European countries, a shift towards time-driven activity-based costing should be advocated.
Collapse
Affiliation(s)
- Gregoire Mercier
- CHU de Montpellier, Montpellier, France
- Montpellier Research in Management, Universite Montpellier 1, Montpellier, France
- * E-mail:
| | - Gerald Naro
- Montpellier Research in Management, Universite Montpellier 1, Montpellier, France
| |
Collapse
|
33
|
Hendriks ME, Kundu P, Boers AC, Bolarinwa OA, Te Pas MJ, Akande TM, Agbede K, Gomez GB, Redekop WK, Schultsz C, Swan Tan S. Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action 2014; 7:23573. [PMID: 24685170 PMCID: PMC3970035 DOI: 10.3402/gha.v7.23573] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 11/25/2022] Open
Abstract
Background Disease-specific costing studies can be used as input into cost-effectiveness analyses and provide important information for efficient resource allocation. However, limited data availability and limited expertise constrain such studies in low- and middle-income countries (LMICs). Objective To describe a step-by-step guideline for conducting disease-specific costing studies in LMICs where data availability is limited and to illustrate how the guideline was applied in a costing study of cardiovascular disease prevention care in rural Nigeria. Design The step-by-step guideline provides practical recommendations on methods and data requirements for six sequential steps: 1) definition of the study perspective, 2) characterization of the unit of analysis, 3) identification of cost items, 4) measurement of cost items, 5) valuation of cost items, and 6) uncertainty analyses. Results We discuss the necessary tradeoffs between the accuracy of estimates and data availability constraints at each step and illustrate how a mixed methodology of accurate bottom-up micro-costing and more feasible approaches can be used to make optimal use of all available data. An illustrative example from Nigeria is provided. Conclusions An innovative, user-friendly guideline for disease-specific costing in LMICs is presented, using a mixed methodology to account for limited data availability. The illustrative example showed that the step-by-step guideline can be used by healthcare professionals in LMICs to conduct feasible and accurate disease-specific cost analyses.
Collapse
Affiliation(s)
- Marleen E Hendriks
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands;
| | - Piyali Kundu
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Alexander C Boers
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Oladimeji A Bolarinwa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Mark J Te Pas
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanimola M Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Gabriella B Gomez
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - William K Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
34
|
Tan SS, Geissler A, Serdén L, Heurgren M, van Ineveld BM, Redekop WK, Hakkaart-van Roijen L. DRG systems in Europe: variations in cost accounting systems among 12 countries. Eur J Public Health 2014; 24:1023-8. [DOI: 10.1093/eurpub/cku025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
35
|
The Costs of Developing, Implementing, and Operating a Safety Learning System in Community Practice. J Patient Saf 2013; 9:211-8. [DOI: 10.1097/pts.0000000000000052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Caskey FJ, Jager KJ. A population approach to renal replacement therapy epidemiology: lessons from the EVEREST study. Nephrol Dial Transplant 2013; 29:1494-9. [PMID: 24166464 DOI: 10.1093/ndt/gft390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The marked variation that exists in renal replacement therapy (RRT) epidemiology between countries and within countries requires careful systematic examination if the root causes are to be understood. While individual patient-level studies are undoubtedly important, there is a complementary role for more population-level, area-based studies--an aetiological approach. The EVEREST Study adopted such an approach, bringing RRT incidence rates, survival and modality mix together with macroeconomic factors, general population factors and renal service organizational factors for up to 46 countries. This review considers the background to EVEREST, its key results and then the main methodological lessons and their potential application to ongoing work.
Collapse
Affiliation(s)
- Fergus J Caskey
- Richard Bright Renal Unit, Southmead Hospital, Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
37
|
Ansah EK, Epokor M, Whitty CJM, Yeung S, Hansen KS. Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana. Am J Trop Med Hyg 2013; 89:724-736. [PMID: 23980131 PMCID: PMC3795104 DOI: 10.4269/ajtmh.13-0033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cost-effectiveness information on where malaria rapid diagnostic tests (RDTs) should be introduced is limited. We developed incremental cost-effectiveness analyses with data from rural health facilities in Ghana with and without microscopy. In the latter, where diagnosis had been presumptive, the introduction of RDTs increased the proportion of patients who were correctly treated in relation to treatment with antimalarials, from 42% to 65% at an incremental societal cost of Ghana cedis (GHS)12.2 (US$8.3) per additional correctly treated patients. In the "microscopy setting" there was no advantage to replacing microscopy by RDT as the cost and proportion of correctly treated patients were similar. Results were sensitive to a decrease in the cost of RDTs, which cost GHS1.72 (US$1.17) per test at the time of the study and to improvements in adherence to negative tests that was just above 50% for both RDTs and microscopy.
Collapse
Affiliation(s)
| | | | | | | | - Kristian Schultz Hansen
- *Address correspondence to Kristian Schultz Hansen, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| |
Collapse
|
38
|
|
39
|
Introduction of DRG-based reimbursement in inpatient psychosomatics--an examination of cost homogeneity and cost predictors in the treatment of patients with eating disorders. J Psychosom Res 2012; 73:383-90. [PMID: 23062813 DOI: 10.1016/j.jpsychores.2012.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 08/07/2012] [Accepted: 09/05/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Various western countries are focusing on the introduction of reimbursement based on diagnosis-related groups (DRG) in inpatient mental health. The aim of this study was to analyze if psychosomatic inpatients treated for eating disorders could be reimbursed by a common per diem rate. METHODS Inclusion criteria for patient selection (n=256) were (1) a main diagnosis of anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder-related obesity (OB), (2) minimum length of hospital stay of 2 days, (3) and treatment at Charité Universitaetsmedizin Berlin, Germany during the years 2006-2009. Cost calculation was executed from the hospital's perspective, mainly using micro-costing. Generalized linear models with Gamma error distribution and log link function were estimated with per diem costs as dependent variable, clinical and patient variables as well as treatment year as independent variables. RESULTS Mean costs/case for AN amounted to 5,251€, 95% CI [4407-6095], for BN to 3,265€, 95% CI [2921-3610] and for OB to 3,722€, 95% CI [4407-6095]. Mean costs/day over all patients amounted to 208€, 95% CI [198-218]. The diagnosis AN predicted higher costs in comparison to OB (p=.0009). A co-morbid personality disorder (p=.0442), every one-unit increase in BMI in OB patients (p=.0256), every one-unit decrease in BMI in AN patients (p=.0002) and every additional life year in BN patients (p=.0455) predicted increased costs. CONCLUSION We see a need for refinements to take into account considerable variations in treatment costs between patients with eating disorders due to diagnosis, BMI, co-morbid personality disorder and age.
Collapse
|
40
|
Handleiding voor kostenonderzoek: methoden en referentieprijzen voor economische evaluaties in de gezondheidszorg. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12508-012-0128-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Abstract
OBJECTIVES In 2000, the first "Dutch Manual for Costing: METHODS and Reference Prices for Economic Evaluations in Healthcare" was published, followed by an updated version in 2004. The purpose of the Manual is to facilitate the implementation and assessment of costing studies in economic evaluations. New developments necessitated the publication of a thoroughly updated version of the Manual in 2010. The present study aims to describe the main changes of the 2010 Manual compared with earlier editions of the Manual. METHODS New and updated topics of the Manual were identified. The recommendations of the Manual were compared with the health economic guidelines of other countries, eliciting strengths and limitations of alternative methods. RESULTS New topics in the Manual concern medical costs in life-years gained, the database of the Diagnosis Treatment Combination (DBC) casemix System, reference prices for the mental healthcare sector and the costs borne by informal care-givers. Updated topics relate to the friction cost method, discounting future effects and options for transferring cost results from international studies to the Dutch situation. CONCLUSIONS The Action Plan is quite similar to many health economic guidelines in healthcare. However, the recommendations on particular aspects may differ between national guidelines in some respects. Although the Manual may serve as an example to countries intending to develop a manual of this kind, it should always be kept in mind that preferred methods predominantly depend on a country's specific context.
Collapse
|
42
|
Haas L, Stargardt T, Schreyoegg J, Schlösser R, Danzer G, Klapp BF. Inpatient costs and predictors of costs in the psychosomatic treatment of anorexia nervosa. Int J Eat Disord 2012; 45:214-21. [PMID: 21374692 DOI: 10.1002/eat.20903] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In German inpatient psychosomatics per diem lump sums will be introduced as reimbursement rates by 2013. It was the aim to calculate total inpatient costs per case for the psychosomatic treatment of patients with anorexia nervosa and to identify cost predictors. METHOD The sample comprised of 127 inpatients. Cost calculation was executed from the hospital's perspective, mainly using microcosting. Medical records provided data on patient characteristics and individual resource use. Two generalized linear models with gamma distribution and log link function were estimated to determine cost predictors by means of demographic data, comorbidities, and body-mass-index at admission. RESULTS Inpatient costs amounted to 4,647 €/6,831 US$ per case (standard deviation 3,714 €/5,460 US$).The admission BMI and "Disorders of Adult Personality and Behavior" were significant cost predictors (p < 0.05). DISCUSSION The formation of patient groups within the diagnosis anorexia nervosa should be oriented towards the determined cost predictors.
Collapse
Affiliation(s)
- Laura Haas
- Department of Psychosomatic Medicine, Charité Medical School, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
43
|
Tan SS, Bakker J, Hoogendoorn ME, Kapila A, Martin J, Pezzi A, Pittoni G, Spronk PE, Welte R, Hakkaart-van Roijen L. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:81-86. [PMID: 22264975 DOI: 10.1016/j.jval.2011.09.007] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The objective of the present study was to measure and compare the direct costs of intensive care unit (ICU) days at seven ICU departments in Germany, Italy, the Netherlands, and the United Kingdom by means of a standardized costing methodology. METHODS A retrospective cost analysis of ICU patients was performed from the hospital's perspective. The standardized costing methodology was developed on the basis of the availability of data at the seven ICU departments. It entailed the application of the bottom-up approach for "hotel and nutrition" and the top-down approach for "diagnostics," "consumables," and "labor." RESULTS Direct costs per ICU day ranged from €1168 to €2025. Even though the distribution of costs varied by cost component, labor was the most important cost driver at all departments. The costs for "labor" amounted to €1629 at department G but were fairly similar at the other departments (€711 ± 115). CONCLUSIONS Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix.
Collapse
Affiliation(s)
- Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Fox AM, Pitzul K, Bhojani F, Kaplan M, Moulton CA, Wei AC, McGilvray I, Cleary S, Okrainec A. Comparison of outcomes and costs between laparoscopic distal pancreatectomy and open resection at a single center. Surg Endosc 2011; 26:1220-30. [PMID: 22179451 DOI: 10.1007/s00464-011-2061-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 11/10/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND The cost implications of laparoscopic distal pancreatectomy (LDP) and a detailed breakdown of hospital expenditures has not been presented in the literature to date. This study aimed to compare hospital costs and short-term clinical outcomes between LDP and open distal pancreatectomy (ODP). METHODS The authors evaluated all the distal pancreatic resections performed at their center between January 2004 and March 2010. Parametric and nonparametric statistical analysis was used to compare hospital departmental and total hospital costs as well as oncologic and surgical outcomes. RESULTS A total of 118 cases (42 laparoscopic resections, including 5 conversions, and 76 open resections) were analyzed. The demographic characteristics were similar between the groups except for a predominance of females in the laparoscopic group (P = 0.036). The indications for surgery differed by a paucity of malignant tumors being approached laparoscopically (P < 0.001). Intraoperatively, there were no differences in estimated blood loss, operating room time, or transfusion requirement. The pathologic outcomes did not differ significantly. The median hospital length of stay (LOS) was 5 days (range 3-31 days) for the LDP cohort and 7 days (range 4-19 days) for the ODP cohort (P < 0.001). Postoperative pancreatic fistula occurred for 22 patients, with a higher proportion observed in the LDP group (28.57%; n = 12) than in the open group (13.16%; n = 10; P = 0.05). However, the rates for grade B and higher grade fistula were higher in the ODP group (0 LDP and 4 ODP). The median preadmission and operative costs did not differ significantly. The ODP cohort had significantly higher costs in all other hospital departments, including the total cost. CONCLUSION LDP is both a cost-effective and safe approach for distal pancreatic lesions. This series showed a shorter LOS and lower total hospital costs for LDP than for ODP, accompanied by equivalent postoperative outcomes.
Collapse
Affiliation(s)
- Adrian M Fox
- Division of General Surgery, University Health Network, 10E212 Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Olsson TM. Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:445-53. [PMID: 20496157 DOI: 10.1007/s10198-010-0257-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 05/06/2010] [Indexed: 05/21/2023]
Abstract
This study compares two approaches to the estimation of social welfare intervention costs: one "top-down" and the other "bottom-up" for a group of social welfare clients with severe problem behavior participating in a randomized trial. Intervention costs ranging over a two-year period were compared by intervention category (foster care placement, institutional placement, mentorship services, individual support services and structured support services), estimation method (price, micro costing, average cost) and treatment group (intervention, control). Analyses are based upon 2007 costs for 156 individuals receiving 404 interventions. Overall, both approaches were found to produce reliable estimates of intervention costs at the group level but not at the individual level. As choice of approach can greatly impact the estimate of mean difference, adjustment based on estimation approach should be incorporated into sensitivity analyses. Analysts must take care in assessing the purpose and perspective of the analysis when choosing a costing approach for use within economic evaluation.
Collapse
Affiliation(s)
- Tina M Olsson
- School of Social Work and Institute for Evidence-Based Social Work Practice, National Board of Health and Welfare, Lund University, Box 117, 221 00, Lund, Sweden.
| |
Collapse
|
46
|
Irvine L, Barton GR, Gasper AV, Murray N, Clark A, Scarpello T, Sampson M. Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes. Int J Technol Assess Health Care 2011; 27:275-82. [PMID: 22004767 DOI: 10.1017/s0266462311000365] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Previous research has suggested people with impaired fasting glucose (IFG) are less likely to develop Type 2 diabetes (T2DM) if they receive prolonged structured diet and exercise advice. This study examined the within-trial cost-effectiveness of such lifestyle interventions. METHODS Screen-detected participants with either newly diagnosed T2DM or IFG were randomized 2:1 to intervention versus control (usual care) between February and December 2009, in Norfolk (UK). The intervention consisted of group based education, physiotherapy and peer support sessions, plus telephone contacts from T2DM volunteers. We monitored healthcare resource use, intervention costs, and quality of life (EQ-5D). The incremental cost per quality-adjusted life-year (QALY) gain (incremental cost effectiveness ratio [ICER]), and cost effectiveness acceptability curves (CEAC) were estimated. RESULTS In total, 177 participants were recruited (118 intervention, 59 controls), with a mean follow-up of 7 months. Excluding screening and recruitment costs, the mean cost was estimated to be £551 per participant in the intervention arm, compared with £325 in the control arm. The QALY gains were -0.001 and -0.004, respectively. The intervention was estimated to have an ICER of £67,184 per QALY (16 percent probability of being cost-effective at the £20,000/QALY threshold). Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up (≥ 4 months) (ICERs of £20,620 and £17,075 per QALY, respectively). CONCLUSIONS Group sessions to prevent T2DM were not estimated to be within current limits of cost-effectiveness. However, there was a large degree of uncertainty surrounding these estimates, suggesting the need for further research.
Collapse
Affiliation(s)
- Lisa Irvine
- Health Economics Group, Norwich Medical School-University of East Anglia, NR4 7TJ Norwich, UK.
| | | | | | | | | | | | | |
Collapse
|
47
|
Oppong R, Coast J, Hood K, Nuttall J, Smith RD, Butler CC. Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:319-329. [PMID: 20364288 DOI: 10.1007/s10198-010-0239-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 03/15/2010] [Indexed: 05/29/2023]
Abstract
The objectives of this study were to estimate the resource use and cost of treating acute cough/lower respiratory tract infection (acute cough/LRTI) in 13 European countries, to explore reasons for differences in cost and to document the challenges that researchers face when collecting information on cost alongside multinational studies. Data on resource use and cost were collected alongside an observational study in 14 primary care networks across 13 European countries and a mean cost was generated for each network. The results show that the mean cost (standard deviation) of treating acute cough/LRTI in Europe ranged from euro23.88 (34.67) in Balatonfüred (Hungary) to euro116.47 (34.29) in Jonkoping (Sweden). The observed differences in costs were statistically significant (P < 0.01). Major cost drivers include general practitioner visits and drug costs in all networks, whilst differences in health systems and regional factors could account for differences in cost between networks. The major barrier to conducting multinational cost studies are barriers associated with identifying cost information.
Collapse
Affiliation(s)
- Raymond Oppong
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Public Health Building, Birmingham, B15 2TT, UK.
| | | | | | | | | | | |
Collapse
|
48
|
Carreras M, García-Goñi M, Ibern P, Coderch J, Vall-Llosera L, Inoriza JM. Estimates of patient costs related with population morbidity: can indirect costs affect the results? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:289-295. [PMID: 20306112 DOI: 10.1007/s10198-010-0227-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 02/15/2010] [Indexed: 05/29/2023]
Abstract
A number of health economics studies require patient cost estimates as basic information input. However, the accuracy of cost estimates remains generally unspecified. We propose to investigate how the allocation of indirect costs or overheads can affect the estimation of patient costs and lead to improvements in the analysis of patient cost estimates. Instead of focussing on the costing method, this paper will highlight observed changes in variation explained by a methodology choice. We compare four overhead allocation methods for a specific Spanish population adjusted using the Clinical Risk Groups model. Our main conclusion is that the amount of global variation explained by the risk adjustment model depends mainly on direct costs, regardless of the cost allocation methodology used. Furthermore, the variation explained can be slightly increased, depending on the cost allocation methodology, and is independent of the level of aggregation in the classification system.
Collapse
Affiliation(s)
- M Carreras
- Serveis de Salut Integrats del Baix Empordà, DAIR, Hospital 36, 17230, Palamós, Spain.
| | | | | | | | | | | |
Collapse
|
49
|
Geitona M, Hatzikou M, Steiropoulos P, Alexopoulos EC, Bouros D. The cost of COPD exacerbations: a university hospital--based study in Greece. Respir Med 2011; 105:402-9. [PMID: 20970310 DOI: 10.1016/j.rmed.2010.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 09/24/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hospitalization attributed to severe exacerbations is the major cost driver of Chronic Obstructive Pulmonary Disease (COPD). Given that in Greece no previous studies have addressed the economic burden of COPD, the aim of the study was to examine the hospitalization cost of COPD patients with severe exacerbations in the region of Thrace. METHODS Sample consisted of 142 COPD patients with severe exacerbations who were admitted to the pneumonology department of the University Teaching Hospital of Alexandroupolis (UTHA) in 2006 and 2007. Data collection was performed retrospectively and resource utilization was derived from patients' files. General Linear Model univariate analysis was applied in order to test the influence of disease severity on costs. RESULTS Mean actual cost per severe exacerbation was €1711; the amount of €621 is reimbursed by social security funds. Price discrepancies are observed between the actual and the nominal cost per patient in all disease stage categories. Mean hospitalization cost per COPD patient increases slightly with the severity of the disease. However, in the very severe stage it greatly increases mainly due to Intensive Care Unit (ICU) admission. In multivariate analysis the length of stay and the stage of the disease were both related to significantly increased costs, while the existence of co-morbidities exhibited marginal significant relation to increased cost. CONCLUSIONS The cost estimation of severe exacerbations is important as it could trigger further research and also provide the opportunity of creating national epidemiological and economic data. Such data could contribute to the estimation of the total economic and societal burden of COPD in the country.
Collapse
Affiliation(s)
- Mary Geitona
- Department of Social Policy, University of Peloponnese, Korinthos, Greece
| | | | | | | | | |
Collapse
|
50
|
Gavaza P, Shepherd M, Shcherbakova N, Khoza S. The state of health economics and pharmaceoconomics research in Russia: a systematic review. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2010. [DOI: 10.1111/j.1759-8893.2010.00023.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|