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首页> 外文期刊>Health economics >The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches.
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The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches.

机译：使用不同的成本核算方法对心脏保健经济评估结果的影响：微观成本核算与总成本核算方法。

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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 Dollars 16,684, Dollars 16,232, and Dollars 10,474, respectively. Using Monte Carlo simulation, the cost per QALY gained was Dollars 41,764 (95% CI: Dollars 41,182-Dollars 42 346), Dollars 42,538 (95% CI: Dollars 42 167-Dollars 42 907), and Dollars 36,566 (95% CI: Dollars 36,172-Dollars 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.
机译：背景：已发表的有关经济评估的指南几乎没有提供有关不同成本核算方法的使用和潜在偏差的指南。目的：使用微观成本核算和两种总成本核算方法，我们（1）比较了主题内部和各个主题之间的成本估算，并且（2）确定了对经济评估结果的影响。方法：从当地卫生区获得微成本估算，从两个政府机构（一个省和一个国家）获得总成本估算。描述了每种方法的总住院费用。通过对西罗莫司洗脱支架的经济评估，我们比较了采用每种方法所产生的增量成本-效用比率。结果：微观成本核算，Case-Mix-Grouper（CMG）总成本核算和Refined-Diagnosis-Related Grouper（rDRG）总成本核算得出的4年平均成本估计分别为16,684美元，16,232美元和10,474美元。使用Monte Carlo模拟，获得的每个QALY成本为41,764美元（95％CI：41,182美元-42,346美元），42,538美元（95％CI：42,167美元-42,907美元）和36,566美元（95％CI：微成本计算，rDRG衍生和CMG衍生的估算分别为36,172美元-36,960美元（P <0.001）。结论：在主题内，这三种成本核算方法产生了明显不同的成本估算。每种方法产生的成本-效用值之间的差异不大，但可能会影响决定资助新干预措施的程度。

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