Leusder Maura, van Elten Hilco J, Ahaus Kees, Hilders Carina G J M, van Santbrink Evert J P
Department of Health Services, Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
Eur J Health Econ. 2024 Dec 27. doi: 10.1007/s10198-024-01744-5.
Health economic evaluations require cost data as a key input, and reimbursement policies and systems should incentivize valuable care. Subfertility is a growing global phenomenon, and Dutch per-treatment DRGs alone do not support value-based decision-making because they don't reflect patient-level variation or the impact of technologies on costs across entire patient pathways.
We present a real-world micro-costing analysis of subfertility patient pathways (n = 4.190) using time-driven activity-based costing (TDABC) and process mining in the Dutch healthcare system, and built a scalable and granular costing model.
We find that pathways (13.203 treatments, 4.190 patients, 10 years) from referral to pregnancy and birth vary greatly in costs (mean €6.329, maximum €36.976) and duration (mean 25,5 months, maximum 8,59 years), with structural variation within treatments (and DRGs) of up to 65%. Patient-level variation is highest in laboratory phases, and causally related to patients' cycle volume, type, and treatment methods. Large IVF or IVF-ICSI cycles are most common, and most valuable to patients and the healthcare system, but exceed their DRGs significantly (33%). We provide recommendations that reduce costs across patient pathways by €1.3 m in the Netherlands, to support value-based personalized care strategies. These findings are relevant to clinics following European protocols.
Fertility treatments like IVF feature significant cost variation due to the personalization of treatments, and rapidly evolving laboratory technologies. Incorporating cost granularity at the patient and treatment level (cycle volume, type, method) is critical for decision-making, economic analyses, and policy as both subfertility rates and treatment demand are rising.
卫生经济评估需要成本数据作为关键输入，报销政策和系统应激励提供有价值的医疗服务。生育力低下是一个日益全球化的现象，仅荷兰的按治疗诊断相关分组（DRG）并不支持基于价值的决策，因为它们没有反映患者层面的差异或技术对整个患者就医路径成本的影响。
我们在荷兰医疗系统中，使用时间驱动作业成本法（TDABC）和流程挖掘，对生育力低下患者就医路径（n = 4190）进行了真实世界微观成本分析，并构建了一个可扩展且细化的成本模型。
我们发现，从转诊到怀孕和分娩的就医路径（13203次治疗，4190名患者，10年）在成本（平均6329欧元，最高36976欧元）和持续时间（平均25.5个月，最高8.59年）上差异很大，治疗（和DRG）内部的结构差异高达65%。患者层面的差异在实验室阶段最高，并且与患者的周期数量、类型和治疗方法存在因果关系。大型体外受精（IVF）或卵胞浆内单精子注射（IVF-ICSI）周期最为常见，对患者和医疗系统最有价值，但显著超出其DRG（33%）。我们提供的建议可使荷兰患者就医路径的成本降低130万欧元，以支持基于价值的个性化医疗策略。这些发现与遵循欧洲方案的诊所相关。
像IVF这样的生育治疗因治疗的个性化和快速发展的实验室技术而存在显著的成本差异。在患者和治疗层面（周期数量、类型、方法）纳入成本细化对于决策、经济分析和政策制定至关重要，因为生育力低下率和治疗需求都在上升。
