Raikou M, Briggs A, Gray A, McGuire A
City University, London, UK.
Health Econ. 2000 Apr;9(3):191-8. doi: 10.1002/(sici)1099-1050(200004)9:3<191::aid-hec510>3.0.co;2-1.
Costing issues are increasingly being addressed in multi-centre studies. In this paper, two methods for collecting costing information are compared within a simulated clinical trial setting. One method estimates average treatment costs by applying unit costs averaged across treatment centres to centre-specific volumes of resource use. The second uses centre-specific information for both the unit costs and the resource volumes, and then averages across centres. Using a pre-specified production relation between the different volumes of resource use, and simulating changes in unit costs, it is shown that these two methods result in statistically different estimates of average treatment costs. This finding holds, regardless of the degree of substitutability between the resource volumes, except when considerable uncertainty surrounds treatment centre responses to relative changes in unit costs. The findings suggest that a more cautious approach should be adopted in the collection, calculation and interpretation of treatment costs in multi-centre studies.
成本问题在多中心研究中越来越受到关注。本文在模拟临床试验环境中比较了两种收集成本信息的方法。一种方法是通过将各治疗中心的平均单位成本应用于特定中心的资源使用量来估算平均治疗成本。第二种方法则使用特定中心的单位成本和资源使用量信息，然后在各中心之间求平均值。利用不同资源使用量之间预先设定的生产关系，并模拟单位成本的变化，结果表明这两种方法得出的平均治疗成本估计值在统计学上存在差异。无论资源使用量之间的替代程度如何，这一发现都成立，除非治疗中心对单位成本相对变化的反应存在相当大的不确定性。研究结果表明，在多中心研究中，在收集、计算和解释治疗成本时应采取更为谨慎的方法。
