The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches.

Autor: Clement Nee Shrive FM; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada., Ghali WA, Donaldson C, Manns BJ
Jazyk: angličtina
Zdroj: Health economics [Health Econ] 2009 Apr; Vol. 18 (4), pp. 377-88.
DOI: 10.1002/hec.1363
Abstrakt: Background: Published guidelines on the conduct of economic evaluations provide little guidance regarding the use and potential bias of the different costing methods.
Objectives: Using microcosting and two gross-costing methods, we (1) compared the cost estimates within and across subjects, and (2) determined the impact on the results of an economic evaluation.
Methods: Microcosting estimates were obtained from the local health region and gross-costing estimates were obtained from two government bodies (one provincial and one national). Total inpatient costs were described for each method. Using an economic evaluation of sirolimus-eluting stents, we compared the incremental cost-utility ratios that resulted from applying each method.
Results: Microcosting, Case-Mix-Grouper (CMG) gross-costing, and Refined-Diagnosis-Related grouper (rDRG) gross-costing resulted in 4-year mean cost estimates of $16,684, $16,232, and $10,474, respectively. Using Monte Carlo simulation, the cost per QALY gained was $41,764 (95% CI: $41,182-$42 346), $42,538 (95% CI: $42 167-$42 907), and $36,566 (95% CI: $36,172-$36,960) for microcosting, rDRG-derived and CMG-derived estimates, respectively (P<0.001).
Conclusions: Within subject, the three costing methods produced markedly different cost estimates. The difference in cost-utility values produced by each method is modest but of a magnitude that could influence a decision to fund a new intervention.
((c) 2008 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
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