Estimation du coût hospitalier : approches par « micro-costing » et « gross-costing »

Guerre, P.; Hayes, Nathalie; Bertaux, Anne-Claire

doi:10.1016/j.respe.2018.02.001

Cited by 15 publications

(10 citation statements)

References 9 publications

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“…Bottom-up micro-costing provides precise cost estimates by meticulously tracking every resource used in patient care. It offers high accuracy but demands extensive data collection, making it resource-intensive and potentially less feasible for large-scale studies ( 6 , 8 ). An alternative approach has shown promise in estimating costs of ED care.…”

Section: Discussionmentioning

confidence: 99%

“…At present, there are no specific guidelines regarding the number of patients to include or the minimum level of precision required in micro-costing studies ( 8 ). To the best of the authors’ knowledge, there is no micro-costing study in the literature focusing on the costs of ED care for specific clinical pathways.…”

Section: Methodsmentioning

confidence: 99%

“…It enables the monetization of resources consumption observed at an individual level, thereby facilitating the calculation of a per patient cost of care which will be used to estimate the average cost of the intervention studied. This stands in contrast to the top-down method, which assigns each patient an average cost based on aggregated data ( 8 ). While the bottom-up micro-costing method is considered the gold standard for hospital cost estimation due to its precision ( 3 ), its practical implementation is often limited due to a significant consumption of labor time and resources ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Micro-costing analysis of suspected lower respiratory tract infection care in a French emergency department

Wilmé,

Sauleau,

Le Borgne

et al. 2023

Front. Public Health

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IntroductionIn the context of budgetary constraints faced by healthcare systems, the medical-economic evaluation of care strategies becomes essential. In particular, valuing consumed resources in the overcrowded emergency departments (EDs) has become a priority to adopt more efficient approaches in treating the growing number of patients. However, precisely measuring the cost of care is challenging. While bottom-up micro-costing is considered the gold standard, its practical application remains limited.ObjectiveThe objective was to accurately estimate the ED care cost for patients consulting in a French ED for suspected lower respiratory tract infection.MethodsThe authors conducted a cost analysis using a bottom-up micro-costing method. Patients were prospectively included between January 1, and March 31, 2023. The primary endpoint was the mean cost of ED care. Resources consumed were collected using direct observation method and cost data were obtained from information available at Strasbourg University Hospital.ResultsThe mean cost of ED care was €411.68 (SD = 174.49). The cost elements that made the greatest contribution to the total cost were laboratory tests, labor, latency time, imaging and consumables. Considering this cost and the current epidemiological data on respiratory infections in France, the absence of valuation for outpatient care represents an annual loss of over 17 million euros for healthcare facilities.ConclusionMicro-costing is a key element in valuing healthcare costs. The importance of accurately measuring costs, along with measuring the health outcomes of a defined care pathway, is to enhance the relevance of health economic evaluations and thus ensure efficient care.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Micro-costing analysis of suspected lower respiratory tract infection care in a French emergency department

Wilmé,

Sauleau,

Le Borgne

et al. 2023

Front. Public Health

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“…The cost analysis performed is therefore a micro-costing analysis from the hospital perspective. This approach is frequently used in healthcare because of its accuracy and is recommended for cost elements with high inter-patient variability 11 12. An accurate estimate of each cost would allow a predictive evolution of costs to follow the evolution of the cost activity.…”

Section: Methodsmentioning

confidence: 99%

Automation of parenteral nutrition: impact on process and cost analysis

et al. 2023

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ObjectivesOn the basis of its safety and accuracy, automation is recommended for parenteral nutrition (PN). The aim of this study was to highlight the changes in practices related to the automation of PN and to perform a cost study comparing manual vs automated production costs.MethodsWe conducted a micro-costing study using 1 year of manual production data for adult, neonatal and paediatric PN bagsat a hospital. We used the data to estimate the costs of automating the production process for adult, neonatal and paediatric bags.ResultsMajor modification to the PN production process resulted in: rationalisation of raw materials, computerisation and optimisation of human needs. Switching from a manual to an automated process reduced the cost of neonatal/paediatric custom bags (€130.73 vs €124.58) and semi-custom bags (€172.08 vs €166.86); but increased the cost of adult bags (€93.06 vs €127.92).ConclusionsThe changes resulting from the automation and revision of the production process globally increased annual expenditures by approximately 9.7%. However, automation minimised the risk of misproduction, bag contamination, and led to a more secure production process that reduced risks incurred by the teams. In view of the gain in patient and staff safety (linked to the use of an automated compounding device) the moderate economic impact (<10%) should not deter the automation of PN production circuits.

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“…Direct costs comprised drugs, imaging, pathology and staff salaries. A bottom-up approach was taken for drugs, fluids and diagnostics, 16 , 17 with a top-down methodology for salaries. 9 , 14 All salaries were based on standard hourly rates using mid-level classification of staff.…”

Section: Methodsmentioning

confidence: 99%

A microcosting analysis of ICU expenditure in the interval between brain death and organ donation

Bowtell¹,

Ankravs²,

Fazio³

et al. 2021

Critical Care and Resuscitation

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OBJECTIVE: The cost of providing care in an intensive care unit (ICU) after brain death to facilitate organ donation is unknown. The objective of this study was to estimate expenditure for the care delivered in the ICU between the diagnosis of brain death and subsequent organ donation. DESIGN: Cohort study of direct and indirect costs using bottom-up and top-down microcosting techniques. SETTING: Single adult ICU in Australia. PARTICIPANTS: All patients who met criteria for brain death and proceeded to organ donation during a 13-month period between 1 January 2018 and 31 January 2019. MAIN OUTCOME MEASURES: A comprehensive cost estimate for care provided in the ICU from determination of brain death to transfer to theatre for organ donation. RESULTS: Forty-five patients with brain death became organ donors during the study period. The mean duration of post-death care in the ICU was 37.9 hours (standard deviation [SD], 16.5) at a mean total cost of $7520 (SD, $3136) per donor. ICU staff salaries were the greatest contributor to total costs, accounting for a median proportion of 0.72 of total expenditure (interquartile range, 0.68–0.75). CONCLUSIONS: Substantial costs are incurred in ICU for the provision of patient care in the interval between brain death and organ donation.

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Estimation du coût hospitalier : approches par « micro-costing » et « gross-costing »

Cited by 15 publications

References 9 publications

Micro-costing analysis of suspected lower respiratory tract infection care in a French emergency department

Micro-costing analysis of suspected lower respiratory tract infection care in a French emergency department

Automation of parenteral nutrition: impact on process and cost analysis

A microcosting analysis of ICU expenditure in the interval between brain death and organ donation

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