Hrifach Abdelbaste, Brault Coralie, Couray-Targe Sandrine, Badet Lionel, Guerre Pascale, Ganne Christell, Serrier Hassan, Labeye Vanessa, Farge Pierre, Colin Cyrille
Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité d'Evaluation Médico-Economique, 162, avenue Lacassagne - Bâtiment A, 69424, Lyon, Cedex 03, France.
Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008, Lyon, France.
Health Econ Rev. 2016 Dec;6(1):53. doi: 10.1186/s13561-016-0133-3. Epub 2016 Nov 28.
The costing method used can change the results of economic evaluations. Choosing the appropriate method to assess the cost of organ recovery is an issue of considerable interest to health economists, hospitals, financial managers and policy makers in most developed countries.
The main objective of this study was to compare a mixed method, combining top-down microcosting and bottom-up microcosting versus full top-down microcosting to assess the cost of organ recovery in a French hospital group. The secondary objective was to describe the cost of kidney, liver and pancreas recovery from French databases using the mixed method.
The resources consumed for each donor were identified and valued using the proposed mixed method and compared to the full top-down microcosting approach. Data on kidney, liver and pancreas recovery were collected from a medico-administrative French database for the years 2010 and 2011. Related cost data were recovered from the hospital cost accounting system database for 2010 and 2011. Statistical significance was evaluated at P < 0.05.
All the median costs for organ recovery differ significantly between the two costing methods (non-parametric test method; P < 0.01). Using the mixed method, the median cost for recovering kidneys was found to be €5155, liver recovery was €2528 and pancreas recovery was €1911. Using the full top-down microcosting method, median costs were found to be 21-36% lower than with the mixed method.
The mixed method proposed appears to be a trade-off between feasibility and accuracy for the identification and valuation of cost components when calculating the cost of organ recovery in comparison to the full top-down microcosting approach.
所采用的成本核算方法会改变经济评估的结果。选择合适的方法来评估器官获取成本是大多数发达国家的卫生经济学家、医院、财务经理和政策制定者相当关注的一个问题。
本研究的主要目的是比较一种混合方法（将自上而下的微观成本核算和自下而上的微观成本核算相结合）与完全自上而下的微观成本核算方法，以评估法国一家医院集团的器官获取成本。次要目的是使用混合方法描述从法国数据库中获取肾脏、肝脏和胰腺的成本。
使用所提议的混合方法确定并评估每个供体所消耗的资源，并与完全自上而下的微观成本核算方法进行比较。从法国医疗行政数据库收集2010年和2011年肾脏、肝脏和胰腺获取的数据。相关成本数据从2010年和2011年医院成本核算系统数据库中获取。在P < 0.05水平评估统计学显著性。
两种成本核算方法之间器官获取的所有中位数成本均存在显著差异（非参数检验方法；P < 0.01）。使用混合方法时，发现获取肾脏的中位数成本为5155欧元，肝脏获取为2528欧元，胰腺获取为1911欧元。使用完全自上而下的微观成本核算方法时，中位数成本比混合方法低21% - 36%。
与完全自上而下的微观成本核算方法相比，所提议的混合方法在计算器官获取成本时，对于成本构成部分的识别和评估而言，似乎是可行性与准确性之间的一种权衡。
