Estimates of Patient Costs Related with Population Morbidity: Can Indirect Costs Affect the Results?

Carreras, Marc; García-Goñi, Manuel; Ibern, Pere; Coderch, Jordi; Vall-llosera, Laura; Inoriza, José María

doi:10.2139/ssrn.1374288

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…For all the medical procedures (N09, N07D, A48, and N03), the mean of indirect costs calculated by CVU method is in the range between marginal mark‐up and LOS method. Carreras et al () reported that the selection of an overhead allocation methodology does not produce significant distortion of results. Our study did not confirm this finding, indeed, the CVU method is significantly different from LOS method and marginal mark‐up method.…”

Section: Discussion Of Resultsmentioning

confidence: 99%

Development of clinical value unit method for calculating patient costs

2019

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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.

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Section: Discussion Of Resultsmentioning

confidence: 99%

Development of clinical value unit method for calculating patient costs

2019

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“…Step 1: Identify the study question or technologies to be assessed Microcosting studies can be conducted from two main perspectives: healthcare systems (e.g., heart transplant programs) or healthcare facilities (e.g., left ventricular assistance device procedure in hospital settings) [22]. When the first one is used, microcosting supports economic evaluations that guide health policies.…”

Section: Microcosting With the 8-step Tdabc Frameworkmentioning

confidence: 99%

“…Traditional methods usually do not breakdown cost according to the patient's actual utilization [6]. Those methods usually rely on a top-down perspective, which causes a loss of accuracy [22]: for example, the costs of a given department may be divided by the number of beds, including the cost of nursing, and thus it is not possible to explore the level of complexity and resource demanded by individual patients.…”

Section: Healthcare Decision-making Opportunities Using Tdabcmentioning

confidence: 99%

An 8-step framework for implementing time-driven activity-based costing in healthcare studies

et al. 2019

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Micro-costing studies still deserving for methods orientation that contribute to achieve a patient-specific resource use level of analysis. Time-driven activity-based costing (TDABC) is often employed by health organizations in micro-costing studies with that objective. However, the literature shows many deviations in the implementation of TDABC, which might compromise the accuracy of the results obtained. One reason for that can be attributed to the non-existence of a step-by-step orientation to conduct cost analytics with the TDABC specific for micro-costing studies in healthcare. This article aimed at exploring the literature and practical cases to propose an eight-step framework to apply TDABC in micro-costing studies for health care organizations. The 8-step TDABC framework is presented and detailed exploring online spreadsheets already coded to demonstrate data structure and math formula building. A list of analyses that can be performed is suggested, including an explanation about the information that each analysis can provide to increase the organization capability to orient decision making. The case study developed show that actual micro-costing of health care processes can be achieved with the 8-step TDABC framework and its use in future researches can contribute to increase the number of studies that achieve high-quality level in cost information, and consequently, in health resource evaluation.

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“…La literatura revisada revela que muy pocos trabajos se han referido a establecer los efectos de las metodologías de asignación de CIE en otras variables dependientes, uno de ellos es el de Tan SS, van Ineveld BM, Redekop WK, et al (2009), que se refiere al impacto de cuatro opciones de cálculo de tasas sobre cuatro servicios sanitarios 14 . El segundo trabajo 14 , tuvo como objetivo comparar cuatro opciones de asignación o reparto hacia centros de costos para determinar cuál de ellas permitía una mejor predicción de costos por paciente 15 .…”

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“…Los estudios publicados muestran un amplio rango de porcentajes de agregación de costos indirectos estructurales a los servicios de salud, que fluctúa entre un mínimo de 10% y un máximo de 44% sobre los costos directos [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] .…”

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Impacto de diferentes métodos de asignación de costos indirectos estructurales de hospitales públicos, en el ranking costo-efectividad de 47 intervenciones en salud

2017

Rev. méd. Chile

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Impact of different overhead cost allocation methods of public hospitals on the cost-effectiveness ranking of 47 health programs Background: Costs allocation methods are important for economic evaluation of health care. Aim: To evaluate the impact of overhead costs rates of different hospitals on the cost-effectiveness rankings of health programs. Material and Methods: Using the cost reports from eight hospitals, a Montecarlo simulation was implemented, programming the complete micro-costing algorithm to calculate the final cost of 47 health care interventions, from the health sector perspective. The independent variables considered were the overhead cost rates per establishment and the actual overhead costs. Changing these variables, resulted in changes of the final cost of interventions and cost-effectiveness ratios. Finally the probabilities of changes in the cost-effectiveness ranking of each intervention were calculated. Results: Thirteen programs did not change their ranking order. However, 34 interventions modified their position with different occurrence probabilities. In the new proposed ranking, 21 programs changed their position from one to six places. Conclusions: Different overhead cost rates, representing different assignation forms, have a relative impact in the cost-effectiveness order. Montecarlo simulation can help to improve the accuracy of ranking assignment.

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Estimates of Patient Costs Related with Population Morbidity: Can Indirect Costs Affect the Results?

Cited by 4 publications

References 24 publications

Development of clinical value unit method for calculating patient costs

Development of clinical value unit method for calculating patient costs

An 8-step framework for implementing time-driven activity-based costing in healthcare studies

Impacto de diferentes métodos de asignación de costos indirectos estructurales de hospitales públicos, en el ranking costo-efectividad de 47 intervenciones en salud

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