Heslin Margaret, Babalola Oluwagbemisola, Ibrahim Fowzia, Stringer Dominic, Scott David, Patel Anita
King's Health Economics, King's College London, London, UK.
King's Health Economics, King's College London, London, UK.
Value Health. 2018 Feb;21(2):185-192. doi: 10.1016/j.jval.2017.02.001.
Estimating individual-level medication costs in an economic evaluation can involve extensive data collection and handling. Implications of detailed versus general approaches are unclear.
To compare costing approaches in a trial-based economic evaluation.
We applied four costing approaches to prescribed medication data from the Tumour necrosis factor inhibitors Against Combination Intensive Therapy randomized controlled trial. A detailed micro-costing approach was used as a base case, against which other approaches were compared: costing medications used by at least 1.5% of patients; costing medications on the basis of only chemical name; applying a generic prescription charge rather than a medication-specific cost. We quantitatively examined resulting estimates of prescribed medication and total care costs, and qualitatively examined trial conclusions.
Medication costs made up 6% of the total health and social care costs. There was good agreement in prescribed medication costs (concordance correlation coefficient [CCC] 0.815, 0.819, and 0.989) and excellent agreement in total costs (CCC 0.990, 0.995, and 0.995) between approaches 1 and 2. Approaches 3 and 4 had poor agreement with approach 1 on prescribed medication costs (CCC 0.246-0.700 and 0.033-0.333, respectively), but agreement on total care costs remained good (CCC 0.778-0.993 and 0.729-0.986, respectively).
Because medication costs comprised only a small proportion of total costs, the less resource-intensive approaches had substantial impacts on medication cost estimates, but had little impact on total care costs and did not significantly impact the trial's cost-effectiveness conclusions. There is room for research efficiencies without detriment to an evaluation in which medication costs are likely to form a small proportion of total costs.
在经济评估中估算个体层面的药物成本可能涉及大量的数据收集和处理。详细方法与一般方法的影响尚不清楚。
在基于试验的经济评估中比较成本核算方法。
我们将四种成本核算方法应用于肿瘤坏死因子抑制剂对比联合强化治疗随机对照试验的处方药物数据。以详细的微观成本核算方法作为基准案例，与其他方法进行比较：对至少1.5%的患者使用的药物进行成本核算；仅根据化学名称对药物进行成本核算；采用通用处方费用而非特定药物成本。我们定量检查了处方药物和总护理成本的最终估算值，并定性检查了试验结论。
药物成本占卫生和社会护理总成本的6%。方法1和方法2在处方药物成本方面一致性良好（一致性相关系数[CCC]分别为0.815、0.819和0.989），在总成本方面一致性极佳（CCC分别为0.990、0.995和0.995）。方法3和方法4在处方药物成本方面与方法1的一致性较差（CCC分别为0.246 - 0.700和0.033 - 0.333），但在总护理成本方面的一致性仍然良好（CCC分别为0.778 - 0.993和0.729 - 0.986）。
由于药物成本仅占总成本的一小部分，资源密集度较低的方法对药物成本估算有重大影响，但对总护理成本影响不大，且未显著影响试验的成本效益结论。在不损害药物成本可能占总成本较小比例的评估的情况下，存在提高研究效率的空间。
