Balas E A, Kretschmer R A, Gnann W, West D A, Boren S A, Centor R M, Nerlich M, Gupta M, West T D, Soderstrom N S
School of Medicine, University of Missouri, Columbia 65211, USA.
JAMA. 1998 Jan 7;279(1):54-7. doi: 10.1001/jama.279.1.54.
In the present era of cost containment, physicians need reliable data about specific interventions. The objectives of this study were to assist practitioners in interpretation of economic analyses and estimation of their own costs of implementing recommended interventions.
MEDLINE search from 1966 through 1995 using the text words cost or expense and medical subject heading (MeSH) terms costs and cost analysis, cost control, cost of illness, cost savings, or cost-benefit analysis.
The 4 eligibility criteria were clinical trial with random assignment; health care quality improvement intervention tested; effects measured on the process or outcome of care; and cost calculation mentioned in the report.
After independent abstraction and after consensus development, financial data were entered into a costing protocol to determine which costs related to the intervention were provided.
Of 181 articles, 97 (53.6%) included actual numbers on the costs of the intervention. Of 97 articles analyzed, the most frequently reported cost figures were in the category of operating expenses (direct cost, 61.9%; labor, 42.3%; and supplies, 32.0%). General overhead was not presented in 91 (93.8%) of the 97 studies. Only 14 (14.4%) of the 97 studies mentioned start-up costs. The text word $ in the abstract and the most useful MeSH index term of cost-benefit analysis appeared with nearly equal frequency in the articles that included actual cost data (37.1 % vs 35.1%). Two thirds of articles indexed with the MeSH term cost control did not include cost figures.
Statements regarding cost without substantiating data are made habitually in reports of clinical trials. In clinical trial reports presenting data on expenditures, start-up costs and general overhead are frequently disregarded. Practitioners can detect missing information by placing cost data in a standardized protocol. The costing protocol of this study can help bridge care delivery and economic analyses.
在当前成本控制的时代，医生需要有关特定干预措施的可靠数据。本研究的目的是帮助从业者解读经济分析，并估算他们自己实施推荐干预措施的成本。
使用文本词“成本”或“费用”以及医学主题词（MeSH）“成本”“成本分析”“成本控制”“疾病成本”“成本节约”或“成本效益分析”，对1966年至1995年期间的MEDLINE进行检索。
4项入选标准为随机分配的临床试验；经过测试的医疗质量改进干预措施；对医疗过程或结果进行测量的效果；以及报告中提及的成本计算。
在独立提取并达成共识后，将财务数据输入成本核算方案，以确定哪些与干预措施相关的成本得到了提供。
在181篇文章中，97篇（53.6%）包含了干预措施成本的实际数字。在分析的97篇文章中，最常报告的成本数字属于运营费用类别（直接成本，61.9%；劳动力，42.3%；物资，32.0%）。97项研究中有91项（93.8%）未列出一般间接费用。97项研究中只有14项（14.4%）提到了启动成本。在包含实际成本数据的文章中（37.1%对35.1%），摘要中的文本词“$”和最有用的MeSH索引词“成本效益分析”出现的频率几乎相同。三分之二标有MeSH词“成本控制”的文章未包含成本数字。
在临床试验报告中，习惯性地会出现没有确凿数据的成本陈述。在提供支出数据的临床试验报告中，启动成本和一般间接费用经常被忽视。从业者可以通过将成本数据放入标准化方案中来发现缺失的信息。本研究的成本核算方案有助于衔接医疗服务提供和经济分析。
