Chrischilles E A, Scholz D A
Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City 52242, USA.
Clin Perform Qual Health Care. 1999 Apr-Jun;7(2):107-11.
This paper explains practical approaches for collecting inpatient cost data for cost-of-illness and cost-effectiveness analyses. The economic definition of cost of an item is the value of the resources that are consumed in its production. Cost analysis should collect the resources hypothesized to be affected by the illness or intervention. The dollar value of these resources can also be estimated. Diagnosis-related group (DRG) reimbursements are not helpful when all study patients have the same DRG or when no DRG exists (e.g., nosocomial infection). Hospital charges are not a good surrogate for costs. Hence, data needed include resources used, charges, and cost-to-charge ratios, so that cost can be estimated. Resources used can be obtained from hospital information systems. For some resource use (e.g., physician services, pharmacy, and intravenous fluids), charges or cost-to-charge ratios may not be available, and an external standard may be needed to estimate the dollar value. For many types of resources, hospital financial systems provide both charges and cost-to-charge ratios. This yields an estimate of average cost (total cost divided by patient days) when marginal cost (change in variable cost per day of patient stay) is a better estimate of the value of the resources consumed. However, cost-to-charge ratios remain the only practical way of estimating cost in many circumstances and are commonly used in economic studies. Cost-of-illness estimates vary among the various nonrandomized study designs used. "Real-world" randomized trials are potentially useful to obtain advantages of randomization but avoid the protocol-induced biases of traditional double-blind controlled trials.
本文阐述了为疾病成本分析和成本效益分析收集住院患者成本数据的实用方法。一项物品成本的经济学定义是其生产过程中所消耗资源的价值。成本分析应收集假设受疾病或干预措施影响的资源。这些资源的货币价值也可以估算。当所有研究患者具有相同的诊断相关分组（DRG）或不存在DRG时（如医院感染），DRG报销并无帮助。医院收费并非成本的良好替代指标。因此，所需数据包括所使用的资源、收费以及成本与收费比率，以便能够估算成本。所使用的资源可从医院信息系统获取。对于某些资源使用情况（如医生服务、药房和静脉输液），可能无法获得收费或成本与收费比率，可能需要外部标准来估算货币价值。对于许多类型的资源，医院财务系统会提供收费和成本与收费比率。当边际成本（患者住院每天可变成本的变化）是对所消耗资源价值的更好估计时，这会得出平均成本（总成本除以患者住院天数）的估计值。然而，在许多情况下，成本与收费比率仍然是估算成本的唯一实用方法，并且在经济研究中普遍使用。在使用的各种非随机研究设计中，疾病成本估计各不相同。“真实世界”随机试验对于获得随机化的优势可能有用，但可避免传统双盲对照试验中由方案引起的偏差。
