Medical Transportation Costs In France: Which Source To Estimate Them In Health-Economic Analysis?

Abstract

French Health Authority guidelines recommend to adopt a collective perspective in cost efficacy and cost utility studies. Consequently, medical transportation costs should be included in these studies. Medical transportation expenditures covered by the French Health Insurance were amounted to € 4 billion in 2013. Nevertheless, detailed and specific data sources in France are limited to collect the medical transportation costs. The main objective is to determinate a standardized method allowing to estimate medical transportation costs in French health economics analysis. Medical transportation costs sources have been collected from efficiency opinions published by the French Health Autority (HAS). Then, these costs and their methodologies have been analyzed and completed by a literature search. Out of 31 efficiency opinions analyzed, 70% (22) revealed not to use any medical transportation costs or the specific methodology used for this cost was not mentioned. In the other 30% (9) efficiency opinions, a significant variation in transportation costs was observed ranging from € 9.89 up to € 96.90. One reference is mainly used. The Cour des comptes report, published in 2012, allows to determine the percentage of patients which is reimbursed by the French Health Insurance and the mean cost per transportation. Two methods can be distinguished, resulting in very different mean cost of transportation to use. The first takes into account the percentage of patients who is reimbursed by the French Health Insurance and patients who are not reimbursed. The second only considers reimbursed cost for all patients. Medical transportation cost estimation collected in efficiency opinions from HAS underlines a high degree of heterogeneity on these costs as well as a poor data source available in the literature or on database. Recommendations are needed to avoid this problem.