Micro-costing in health and medicine: a critical appraisal

Xiao Xu, Christina M Lazar, Jennifer Prah Ruger, Xiao Xu, Christina M Lazar, Jennifer Prah Ruger

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.

Keywords: Economic evaluation; Health and medicine; Micro-costing; Resource allocation.

Conflict of interest statement

No competing interests to declare.

References

    1. Gold M, Siegel J, Russell L, Weinstein MC. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
    1. Drummond M, Jefferson T. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ economic evaluation working party. BMJ. 1996;313:275–283. doi: 10.1136/bmj.313.7052.275.
    1. Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. Int J Technol Assess Health Care. 2005;21:240–245. doi: 10.1017/S0266462305050324.
    1. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E. ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated health economic evaluation reporting standards (CHEERS) - Explanation and elaboration: A report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16:231–250. doi: 10.1016/j.jval.2013.02.002.
    1. Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG, editors. Cost-effectiveness in health and medicine. 2. New York: Oxford University Press; 2016.
    1. Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, Kuntz KM, Meltzer DO, Owens DK, Prosser LA, Salomon JA, Sculpher MJ, Trikalinos TA, Russell LB, Siegel JE, Ganiats TG. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316:1093–1103. doi: 10.1001/jama.2016.12195.
    1. 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. doi: 10.2196/resprot.6263.
    1. Fukuda H, Imanaka Y. Assessment of transparency of cost estimates in economic evaluations of patient safety programmes. J Eval Clin Pract. 2009;15:451–459. doi: 10.1111/j.1365-2753.2008.01033.x.
    1. Clement Nee Shrive FM, Ghali WA, Donaldson C, Manns BJ. The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches. Health Econ. 2009;18:377–388. doi: 10.1002/hec.1363.
    1. Demeere J, Merckx C, Demeere N. Cost minimisation and cost effectiveness in anaesthesia for total hip replacement surgery, in Belgium? A study comparing three general anaesthesia techniques. Acta Anaesthesiol Belg. 2006;57:145–151.
    1. Shrestha RK, Sansom SL, Farnham PG. Comparison of methods for estimating the cost of human immunodeficiency virus-testing interventions. J Public Health Manag Pract. 2012;18:259–267. doi: 10.1097/PHH.0b013e31822b2077.
    1. Tan SS, Rutten FF, van Ineveld BM, Redekop WK, Hakkaart-van RL. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2009;10:39–45. doi: 10.1007/s10198-008-0101-x.
    1. Olsson TM. Comparing top-down and bottom-up costing approaches for economic evaluation within social welfare. Eur J Health Econ. 2011;12:445–453. doi: 10.1007/s10198-010-0257-z.
    1. Mercier G, Naro G. Costing hospital surgery services: the method matters. PLoS One. 2014;9:e97290. doi: 10.1371/journal.pone.0097290.
    1. Wordsworth S, Ludbrook A, Caskey F, Macleod A. Collecting unit cost data in multicentre studies. Eur J Health Econ. 2005;6:38–44. doi: 10.1007/s10198-004-0259-9.
    1. Barnett PG. An improved set of standards for finding cost for cost-effectiveness analysis. Med Care. 2009;47:S82–SS8. doi: 10.1097/MLR.0b013e31819e1f3f.
    1. Frick KD. Microcosting quantity data collection methods. Med Care. 2009;47:S76–S81. doi: 10.1097/MLR.0b013e31819bc064.
    1. U.S. Department of Veteran Affairs, Measuring the Cost of a Program of Practice: Microcosting, accessed here: . Accessed 14 Dec 2020.
    1. Mansfied M. Micro-costing analysis: a measure of accountability. American Journal of Ocupational Therapy April 30, 2020. Published online accessible here: .

Source: PubMed

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