What is the value of collecting detailed costing data in clinical trials?

Abstract

Cost data for trial-based economic evaluation can be obtained through micro-costing (collecting resource use and unit cost data for each centre or patient), grosscosting (average costs based on top-line budgets) or provider tariffs (e.g. healthcare resource groups, HRGs). Most studies use a combination of approaches due to data availability, although there is little guidance on which is best. We report a systematic comparison of the three costing approaches in IVAN: a non-inferiority randomised controlled factorial trial of treatment regimens for age-related macular degeneration (AMD), where policy makers are interested in the efficacy and cost-effectiveness of two dosing regimens of bevacizumab (Avastin) and ranibizumab (Lucentis). We aimed to assess the extent to which micro-costing, gross-costing and HRGs differ, and to investigate resource use variation between UK hospitals and explore possible reasons for this variability.

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

“…This could induce omitted-variable bias, if methodological differences were correlated with regression variables, or if cost estimates were biased systematically. For example, it has been observed that costing studies may over- or underestimate costs due to the costing approach used (i.e., gross costing vs. micro-costing [ 56 ]) or may underestimate costs due to the exclusion of relevant intervention cost categories [ 57 ]. In our analysis, we saw that excluding outliers changed the magnitude, although not the direction, of several regression coefficients, as shown in the results of Appendix Table C. All included studies were reported from the immunization provider perspective, and excluded caregiver/beneficiary time and transportation costs to receive vaccination.…”

A comparison of clinical trial and model-based cost estimates in glaucoma – The case of repeat laser trabeculoplasty In Ontario

“…Given the difficulties associated with direct microcosting measurements, analysts are interested in finding easier methods of cost estimation that are still valid. [10] One such method is the use of modelling in place of direct costing. Gross-costing modelling approaches comprise a number of methods that charge at a more highly-aggregated level of service provision (e.g.…”

Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions

“…If the cost of an intervention is unknown, it can be estimated using a micro-costing or a gross-costing approach. 1,33,36,78,79 In a micro-costing approach (i.e. bottom-up approach), information on the types and quantities of resources consumed as well as their respective unit prices is collected for each intervention component separately.…”

“…It allocates a total budget to specific services, such as physical therapists' visits, using specific allocation rules. 1,33,36,78,81,82 The average intervention cost per patient might, for example, be estimated by simply dividing the total intervention costs by the number of patients. Although gross-costing is a simple and fast approach, it lacks precision and its success depends on the type of routine data available.…”