Abstract
The Dutch guideline for economic evaluations in healthcare provides a reference price for an inpatient day. However, this price is based on an unpublished micro-costing study taking into account the costs of only three hospital units, that is neurology-, paediatric- and surgery unit. We aim to construct a reference price based on all hospital units and assess the impact of this modified reference price on the incremental cost utility ratio (ICUR) of minimally invasive pancreatectomy. We used UK tariffs of inpatients days to compare the average price of an inpatient day at the three hospital units examined in the unpublished Dutch micro-costing study with the average price of an inpatient day at all hospital units. The deviation in inpatient day price of the three units relative to all hospital units was used to convert the Dutch reference price to a modified average overall price. The ICUR of minimally invasive pancreatectomy compared with open distal pancreatectomy was re-estimated using the modified reference price and a sensitivity analysis was performed using the bounds of the 95% CI. The average price of the inpatient day of the three units compared to the overall average showed a deviation of +34.09%. Adjustment of the current reference price would change the inpatient day price from €476 to €355 (95%CI: €275-€615). The modified reference price increases the ICUR from -€23,722 to €4,980 per QALY (sensitivity analysis: -€20,969 - €13,015 per QALY). Our study suggests that the current Dutch reference price is an overestimation that can have a substantial impact on outcomes of economic evaluations. In addition, when performing sensitivity analyses the range applied for the cost of the inpatient day should be set rather wide to account for the variation in the price of inpatient days across hospital units.
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