Determination of costs for the CSRwNP pathway. A time-driven activity-based costing experiment

Abstract

Objectives. The study aims to define the economic resources needed to manage chronic rhinosinusitis with nasal polyposis (CRSwNP), assuming the hospital perspective, based on different patient characteristics, within a 24-month time horizon. Methods. Real-world data were collected in 3 Italian hospitals. A time-driven activity-based costing approach was implemented to map and assess the pathways for CRSwNP. The following drivers were considered: diagnostic services, drugs, consumables, human resources, equipment and overhead costs based on the length of stay. Costs related to management of comorbidities and adverse events were evaluated. Three main groups of patients were identified: ineligible for surgery; having 1 intervention; having more than 1 intervention. The economic absorption of patients who continued corticosteroid treatment was analysed. Results. Patients experiencing 1 intervention had a cost of 3,453.31 € that increased to 4,705.03 € for those who required additional surgery. The cost of intranasal corticosteroids was 649.20 €, whereas the cost of oral corticosteroids was 37.60 € per patient. Conclusions. The results demonstrate the strategic relevance of analytical cost definitions of the clinical pathway for CRSwNP, which can help to support decision makers in the review of internal procedures and in the definition of proper reimbursement tariffs. KEY WORDS: chronic rhinosinusitis with nasal polyposis, CRSwNP, surgical pathway, process mapping, time-driven activity-based costing RIASSUNTO Obiettivi. Lo studio mira a definire i costi per la gestione della rinosinusite cronica con poliposi nasale (CRSwNP), assumendo la prospettiva ospedaliera, in base alle caratteristiche dei pazienti, in un orizzonte temporale di 24 mesi.

Multidimensional Impact of Dupilumab on Chronic Rhinosinusitis with Nasal Polyps: A Complete Health Technology Assessment of Clinical, Economic, and Non-Clinical Domains

“…Occurrence rates for these cases were derived from RCTs [15][16][17] and valued, with their weighted average costs calculated. The cost of treating a patient with FESS was valued by DRG 054 (National Tariff Schedule, Italian NHS perspective), and the cost of OCS treatment was based on dosage, frequency of intake cycles, and cost per package [38], multiplied by the probability of needing rescue OCS treatment.…”