Fischer Claudia, Mayer Susanne, Perić Nataša, Simon Judit
Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
Health Econ Rev. 2022 Aug 3;12(1):42. doi: 10.1186/s13561-022-00390-y.
Valuation is a critical part of the costing process in health economic evaluations. However, an overview of specific issues relevant to the European context on harmonizing methodological requirements for the valuation of costs to be used in health economic evaluation is lacking. We aimed to inform the development of an international, harmonized and multi-sectoral costing framework, as sought in the European PECUNIA (ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions) project.
We conducted a scoping review (information extraction 2008-2021) to a) to demonstrate the degree of heterogeneity that currently exists in the literature regarding central terminology, b) to generate an overview of the most relevant areas for harmonization in multi-sectoral and multi-national costing processes for health economic evaluations, and c) to provide insights into country level variation regarding economic evaluation guidance. A complex search strategy was applied covering key publications on costing methods, glossaries, and international costing recommendations augmented by a targeted author and reference search as well as snowballing. Six European countries served as case studies to describe country-specific harmonization issues. Identified information was qualitatively synthesized and cross-checked using a newly developed, pilot-tested data extraction form.
Costing methods for services were found to be heterogeneous between sectors and country guidelines and may, in practice, be often driven by data availability and reimbursement systems in place. The lack of detailed guidance regarding specific costing methods, recommended data sources, double-counting of costs between sectors, adjustment of unit costs for inflation, transparent handling of overhead costs as well as the unavailability of standardized unit costing estimates in most countries were identified as main drivers of country specific differences in costing methods with a major impact on valuation and cost-effectiveness evidence.
This review provides a basic summary of existing costing practices for evaluative purposes across sectors and countries and highlights several common methodological factors influencing divergence in cost valuation methods that would need to be systematically incorporated and addressed in future costing practices to achieve more comparable, harmonized health economic evaluation evidence.
在卫生经济评估中，估值是成本核算过程的关键部分。然而，目前缺乏一份关于欧洲背景下与统一卫生经济评估中成本估值方法要求相关的具体问题概述。我们旨在为制定一个国际统一的多部门成本核算框架提供信息，正如欧洲PECUNIA（用于多部门国家和国际卫生经济评估的成本核算、资源使用测量和结果估值计划）项目所寻求的那样。
我们进行了一项范围审查（信息提取时间为2008 - 2021年），以a）展示目前文献中关于核心术语存在的异质性程度，b）概述卫生经济评估多部门和多国成本核算过程中最相关的统一领域，以及c）深入了解各国在经济评估指南方面的差异。应用了复杂的搜索策略，涵盖成本核算方法、术语表和国际成本核算建议的关键出版物，并辅以有针对性的作者和参考文献搜索以及滚雪球搜索。六个欧洲国家作为案例研究来描述特定国家的统一问题。使用新开发并经过试点测试的数据提取表对识别出的信息进行定性综合和交叉核对。
发现各部门和国家指南之间服务成本核算方法存在异质性，在实践中，这些方法往往受现有数据可用性和报销系统驱动。缺乏关于特定成本核算方法、推荐数据源、部门间成本重复计算、单位成本通胀调整、间接成本的透明处理以及大多数国家缺乏标准化单位成本估算的详细指南，被确定为成本核算方法中各国差异的主要驱动因素，对估值和成本效益证据有重大影响。
本综述提供了各部门和各国用于评估目的的现有成本核算实践的基本总结，并强调了影响成本估值方法差异的几个常见方法学因素，未来成本核算实践需要系统地纳入并解决这些因素，以获得更具可比性、统一的卫生经济评估证据。
