Comparing systems for costing hospital treatments

Larsen, J; Skjoldborg, Ulla Slothuus

doi:10.1016/j.healthpol.2003.07.004

Cited by 10 publications

(11 citation statements)

References 12 publications

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“…Given the average unit cost at Montpellier University Hospital in 2010 (2 052 Euros), this amount is obviously substantial. These findings corroborate previous work highlighting the sensitivity of inpatient cost estimates to the costing method [9], [11], [13], [14]. We focused on surgery services, while most published studies do not distinguish between surgery and non-surgery services.…”

Section: Discussionsupporting

confidence: 89%

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Costing Hospital Surgery Services: The Method Matters

Mercier

Naro²

2014

PLoS ONE

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BackgroundAccurate hospital costs are required for policy-makers, hospital managers and clinicians to improve efficiency and transparency. However, different methods are used to allocate direct costs, and their agreement is poorly understood. The aim of this study was to assess the agreement between bottom-up and top-down unit costs of a large sample of surgical operations in a French tertiary centre.MethodsTwo thousand one hundred and thirty consecutive procedures performed between January and October 2010 were analysed. Top-down costs were based on pre-determined weights, while bottom-up costs were calculated through an activity-based costing (ABC) model. The agreement was assessed using correlation coefficients and the Bland and Altman method. Variables associated with the difference between methods were identified with bivariate and multivariate linear regressions.ResultsThe correlation coefficient amounted to 0.73 (95%CI: 0.72; 0.76). The overall agreement between methods was poor. In a multivariate analysis, the cost difference was independently associated with age (Beta = −2.4; p = 0.02), ASA score (Beta = 76.3; p<0.001), RCI (Beta = 5.5; p<0.001), staffing level (Beta = 437.0; p<0.001) and intervention duration (Beta = −10.5; p<0.001).ConclusionsThe ability of the current method to provide relevant information to managers, clinicians and payers is questionable. As in other European countries, a shift towards time-driven activity-based costing should be advocated.

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Section: Discussionsupporting

confidence: 89%

“…All other things being equal, the choice of costing method might significantly affect the cost estimates [10], [11], [12]. Few studies have investigated the agreement between bottom-up and top-down microcosting on large samples, which seems to be moderate at best [13].…”

Section: Introductionmentioning

confidence: 99%

Costing Hospital Surgery Services: The Method Matters

Mercier

Naro²

2014

PLoS ONE

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“…The mean length of hospitalization in the present study was 3 days above the national mean in non-instrumented fusion whereas in instrumented fusion and circumferential fusion, the mean length of hospitalization was equal to the national mean [22]. Referring to the work of Larsen et Skjoldborg [14], we would expect hospital charge to be > estimate of Activity-Based-Costing analysis > estimate of Diagnosis-Related-Grouping in non-instrumented fusion, whereas in both instrumented fusion and circumferential fusion, we would expect the three estimates to approach each other. This was the exact picture apart from a deviation of hospital charges in instrumented and circumferential fusion.…”

Section: Discussionmentioning

confidence: 90%

“…A recent Danish study compared different costing systems applied in the treatment of stable angina pectoris and described the expected responses [14]. For short hospitalizations (relative to national means in groups in the case-mix system of Diagnosis-Related-Grouping), the costing systems would relate as follows: estimate of DiagnosisRelated-Grouping > estimate of Activity-Based-Costing analysis > hospital charge.…”

Section: Discussionmentioning

confidence: 99%

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain

et al. 2006

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Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activitybased method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine costeffectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion. A cohort of 136 consecutive patients with chronic low back pain, who were surgically treated from January 2001 through January 2003, was followed until 2 years postoperatively. Operations took place at University Hospital of Aarhus and all patients had either (1) non-instrumented posterolateral lumbar spinal fusion, (2) instrumented posterolateral lumbar spinal fusion, or (3) instrumented posterolateral lumbar spinal fusion + anterior intervertebral support. Analysis of costs was performed at the patient-level, from an administrator's perspective, by means of ActivityBased-Costing. Clinical effects were measured by means of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted analysis (for non-random allocation of patients) was performed in order to reveal the incremental costeffectiveness ratios of (a) posterior instrumentation and (b) anterior support. The costs of non-instrumented posterolateral spinal fusion were estimated at DKK 88,285(95% CI 81,369;95,546), instrumented posterolateral spinal fusion at DKK 94,396(95% CI 89,865;99,574) and instrumented posterolateral lumbar spinal fusion + anterior intervertebral support at DKK 120,759(95% CI 111,981;133,738). The net-benefit of the regimens was significantly affected by smoking and functional disability in psychosocial life areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited, whereas the probability of anterior intervertebral support being cost-effective escalates as willingness-to-pay per effect unit increases. This study reveals useful and hitherto unknown information both about cost-patterns at the patient-level and determinants of cost-effectiveness. The overall conclusion of the p...

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“…Σε σύγκριση με τα παραδοσιακά συστήματα κοστολόγησης των νοσηλευτικών ιδρυμάτων η κοστολόγηση δραστηριοτήτων, μπορεί να υπολογίσει με μεγαλύτερη ακρίβεια το κόστος διαφορετικών υγειονομικών υπηρεσιών ή υποομάδων υπηρεσιών (Larsen & Skjoldborg, 2004;West et al, 1996) και να διευκολύνει την προσπάθεια διοίκησης του κόστους (Devine et al, 2000;Lawson, 2003). González et al, 2005;Grandlich, 2004;Stiles & Mick, 1997;Waters et al, 2001).…”

Section: σύγχροναunclassified

Παραδοσιακά Και Σύγχρονα Συστήματα Κοστολόγησης Για Το Λογισμό Του Κόστους Και Τη Διοίκηση Των Υπηρεσιών Υγείας

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Comparing systems for costing hospital treatments

Cited by 10 publications

References 12 publications

Costing Hospital Surgery Services: The Method Matters

Costing Hospital Surgery Services: The Method Matters

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain

Παραδοσιακά Και Σύγχρονα Συστήματα Κοστολόγησης Για Το Λογισμό Του Κόστους Και Τη Διοίκηση Των Υπηρεσιών Υγείας

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