Average Unit Cost Research Articles

Cost of dialysis in Tanzania: evidence from the provider's perspective.

BackgroundAlthough End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014.MethodsCost calculations are based on the provider perspective and include only the direct cost of dialysis treatment. Cost of drugs and consumables were obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interview with experts at the dialysis unit.ResultsMNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will cause annual costs of 27,440 US$.ConclusionThe cost of dialysis is enormous for a least developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards diseases that are curable, have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all effort must be invested to improve technical efficiency by cutting the enormous unit cost.

Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan.

Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care.

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider’s perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up.

Cost-effectiveness of live oral attenuated human rotavirus vaccine in Tanzania

BackgroundGlobally, diarrhoea is the second leading cause of morbidity and mortality, responsible for the annual loss of about 10% of the total global childhood disease burden. In Tanzania, Rotavirus infection is the major cause of severe diarrhoea and diarrhoeal mortality in children under five years. Immunisation can reduce the burden, and Tanzania added rotavirus vaccine to its national immunisation programme in January 2013. This study explores the cost effectiveness of introducing rotavirus vaccine within the Tanzania Expanded Programme on Immunisation (EPI).MethodsWe quantified all health system implementation costs, including programme costs, to calculate the cost effectiveness of adding rotavirus immunisation to EPI and the existing provision of diarrhoea treatment (oral rehydration salts and intravenous fluids) to children. We used ingredients and step down costing methods. Cost and coverage data were collected in 2012 at one urban and one rural district hospital and a health centre in Tanzania. We used Disability Adjusted Life Years (DALYs) as the outcome measure and estimated incremental costs and health outcomes using a Markov transition model with weekly cycles up to a five-year time horizon.ResultsThe average unit cost per vaccine dose at 93% coverage is US$ 8.4, with marked difference between the urban facility US$ 5.2; and the rural facility US$ 9.8. RV1 vaccine added to current diarrhoea treatment is highly cost effective compared to diarrhoea treatment given alone, with incremental cost effectiveness ratio of US$ 112 per DALY averted, varying from US$ 80–218 in sensitivity analysis. The intervention approaches a 100% probability of being cost effective at a much lower level of willingness-to-pay than the US$609 per capita Tanzania gross domestic product (GDP).ConclusionsThe combination of rotavirus immunisation with diarrhoea treatment is likely to be cost effective when willingness to pay for health is higher than USD 112 per DALY. Universal coverage of the vaccine will accelerate progress towards achievement of the child health Millennium Development Goals.

Cost analysis of routine immunisation in Zambia

BackgroundThis study aimed to inform planning and funding by providing updated, detailed information on total and unit costs of routine immunisation (RI) in Zambia, a GAVI-eligible lower middle-income country with a population of 13 million. MethodsThe exercise was part of a multi-country study on costs and financing of routine immunisation (EPIC) that utilized a common, ingredients-based approach to costing. Data on inputs, prices and outputs were collected in a stratified, random sample of 51 facilities in nine districts between December 2012 and March 2013 using a pre-tested questionnaire. Shared inputs were allocated to RI costs on the basis of tracing factors developed for the study. A comprehensive set of costs were analysed to obtain total and unit costs, at facility and above-facility levels. ResultsThe total annual economic cost of RI was $38.16 million, equivalent to approximately 10% of government health spending. Government contributed 83% of finances. Labour accounted for the lion's share (49%) of total costs followed by vaccines (16%) and travel allowances (12%). Analysis of specific activity costs showed that outreach and facility-based services accounted for half of total economic costs. Costs for managing the program at district, provincial and national levels (above-facility costs) represented 24% of total costs. Average unit costs were $7.18 per dose, $59.32 per infant and $65.89 per DPT3 immunised child, with markedly higher unit costs in rural facilities. Analyses suggest that greater efficiency is associated with higher utilisation levels and urban facility type. ConclusionsTotal and unit costs, and government's contribution, were considerably higher than previous Zambian estimates and international benchmarks. These findings have substantial implications for planners, efficiency improvement and sustainable financing, particularly as new vaccines are introduced. Variations in immunisation costs at facility level warrant further statistical analyses.

The quality and implications of Balance of Care studies: Lessons from a systematic literature review

The Balance of Care approach provides a framework for assessing the relative costs and outcomes of changes in the mix of services provided for a particular client group in a defined geographical area. A 2008/2009 systematic literature review explored how five key aspects of the framework had been operationalised detailing past studies’ methods. However, little has been reported about the quality of these applications, whilst the (positive and negative, internal and external) issues associated with organisations’ capacity to implement study findings (i.e. reconfigure provision) have not been appraised. Against this background, this paper reports the results of a new review that sought to address these gaps and identified 38 examples of the approach’s use since 1970. Reporting standards appeared to have improved over time, but there was no clear relationship between study quality and year of publication. Recent applications generally had large samples, used credible case types and engaged appropriate personnel in specifying optimal care. However, they rarely considered comprehensive costs, cost shifting or outcomes. Factors perceived to assist service reconfiguration included the high quality data the approach provided and the momentum for change it generated. Negative factors were predominantly financial, including increased average unit costs and the need for bridging funds.

Predicting the Likelihood of Cost Overruns: An Empirical Examination of Major Department of Defense Acquisition Programs

This article provides a method for predicting the cost of a major acquisition program five years after program development approval. The authors’ work extends the effort begun by Asher and Maggelet by adjusting for changes in median cost growth factors for each acquisition domain. Procurement average unit costs at program approval and five years afterwards were compared for 101 major United States Department of Defense acquisition programs. Individual program cost growth ratios were gathered into 28 sub-groups, based on the product and year of approval. The authors employed a least squares regression to obtain the equation’s coefficients. In 26 of the 28 groups of data, a comparison of predicted costs to actual costs resulted in very low p-values, leading to the conclusion that the revised formulation is a valid predictor of program cost at the five-year point in product development.

Breaking the Deadlock: Towards a New Intergovernmental Relationship in Canadian Healthcare.

Canadians are, at best, only "marginally confident" in the future of Canada's healthcare system (Nanos and Jenkins 2014). They are skeptical that simply spending more money can address the issues underlying Canadian healthcare, yet they also doubt the country's capacity to harness innovative strategies to improve healthcare (ibid). These issues are central to Canadians' concerns about healthcare reform: increased funding is no guarantee of better quality or access to healthcare and may reinforce inefficient patterns of health spending (Canadian Institute for Health Information 2012). For example, Contandriopoulos showed that since 2007 in Québec, total physician compensation, average physician compensation and average unit cost per service all rose quickly but the total number of services, number of services per capita and average number of services per physician were either level or declined (Contandriopoulos and Perroux 2013). However, simply pressuring provinces and territories to do more with less may also be counterproductive, because it creates immediate delivery pressures that reduce opportunities for careful deliberation of strategies for enduring and meaningful improvement. In this article, we present an approach to making the Canadian healthcare system more effective, efficient and sustainable. The program maintains the autonomy of the provinces and territories while renewing federal leadership. The core idea is to use federal healthcare transfer payments to incentivize greater efficiency, better access, better outcomes and increased health equity. Our goal is to set out this model for discussion. We acknowledge that measuring health outcomes, healthcare quality and health equity is challenging. Developing and implementing such measures will require conceptual development and detailed technical plans that are beyond the scope of this article. Moreover, we can only touch briefly on the political processes required to implement a model that balances federal leadership with provincial autonomy. Our goal here is to stimulate discussion by presenting a new model for funding and delivering healthcare.

Full cost accounting on existing and future municipal solid waste management facilities in Greece

<div> <p>In this work, we performed a detailed full cost accounting for 7 types of existing and planned municipal solid waste management facilities (sanitary landfills, anaerobic digestion, biodrying, incineration, aerobic mechanical and biological, material recovery and waste transfer stations) in Greece. We used investment costs (IC), operating costs (OC) and future (restoration) costs (FC) to calculate the actual total unit cost (€/t) of the above types of facilities in 2012 prices. Mathematical cost functions were developed to describe the total cost (€/t) as a function of the MSW input rate (t/y). Actual data from several operating facilities in Greece were used, as well as estimated costs from facilities that are planned or are under construction in Greece. Results showed that the sanitary landfills follow the economy of scale with an average total unit cost of €45/t. The unit cost of the planned anaerobic digestion facilities ranged from €50 to €104/t. The biodrying facilities’ unit cost ranged from €48 to €138/t, whilst the sole MSW incineration facility was found to have a unit cost of €115/t. Aerobic MBT facilities did not follow the economy of scale. The average total unit cost from 23 MRFs was €32/t. The depreciated investment cost of 18 waste transfer stations (WTS) ranged from €0.5/t to €28/t.</p> </div> <p> </p>

Estimating road management equipment inventory needs and associated purchase costs

This paper presents a method for estimating road management equipment inventory needs and associated purchase costs. The primary feature of this method is to consider historical operations records by road management equipment type and weights by work type based on subjective preferences of the public agencies. The Analytical Hierarchy Process (AHP) is employed as the main tool to reflect the relative importance of a day-to-day road management activity. In order to examine the appropriateness of our method, we performed a case study with 18 regional transportation offices in South Korea. The estimated cost of equipment purchases across these offices was approximately 41 million US dollars based on the 2011 year (when apply average unit cost by equipment), while the actual equipment purchase costs during the same one-year period were about 44 million US dollars. The main reason for the differences of estimates across offices is due to unit cost by equipment, road conditions, relative importance of management tasks, and omission of unused equipment in inventories and use of labor. We also developed estimates using the maximum unit costs by equipment, in order to provide an upper bound to the authorities. Using those values we estimated the annual cost at approximately 60 million dollars. The estimates developed can provide useful information to road authorities when they establish annual plans for road management.

Drinking and Waste Water Price Specificity Formation Process in the Republic of Armenia

In the article represented specificity`s price formation process strength of technical activity hydro social cycle in the Republic of Armenia.Analysis of drinking water consumption is done with respect to three groups: standpoint of interest domestic farms, especially in industry and farmers.Industry included all subjects of services and products maker in economy, which is not included in domestic farms or agriculture fields. Appear from industry field include for example: nitrogenous factory, power generation company, banks holding, railways, hospitals and the others.Drinking water supply and waste water derivations services have six important technical directions in hydro social cycle: water intake, drinking water conditioning, drinking water distribution, waste water collecting, waste water reconditioning and derivations:Here are calculated unit cost, overhead and cross costs for each process fabrication, and corresponding its we create hypothetical named average unit cost, as well as average overhead and cross costs.In the article we analyse, that we can improve water supply options in the domestic farms, industry and agriculture fields.

Cost-effectiveness of socioeconomic support as part of HIV care for the poor in an urban community-based antiretroviral program in Uganda.

Socioeconomic support reduced nonretention in a community-based antiretroviral therapy (ART) program in Uganda. However, resource implications of expanding socioeconomic support are large, and cost-effectiveness analysis can inform budget priorities. We compared the incremental benefits and costs of providing education, food, or both forms of support (dual support) with existing ART services from a health care provider's perspective. Costs and outcome data were collected from a cohort of 2371 adult patients with HIV receiving education, food, or dual support from Reach Out Mbuya between 2004 and 2010. The primary outcome was averted loss to follow-up. The number of follow-up days was calculated for each patient along with accrued service and fixed program costs for the alternative forms of socioeconomic support in USD by standard costing methods. The socioeconomic support types were compared incrementally over the study period. After 7 years, 762 (33%) of the patients were loss to follow-up with 42% of them receiving food. In the presence of providing ART, education support was less costly and more effective than the alternatives. The average unit cost for education, food, and dual support were $237, $538, and $776, respectively. The average total annual costs were $88,643 for education, $538,005 for food, and $103,045 for dual support. Compared with food or dual support, investing in education of the children of ART patients is less costly and more effective in improving patient retention. Reach Out Mbuya should embrace this paradigm shift and channel its resources more efficiently and effectively by focusing on education support.

Economic Impact of Heart Failure According to the Effects of Kidney Failure

Introduction and objectivesTo evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. MethodsObservational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. ResultsThe study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was €10 711.40. The corrected cost in the presence of kidney failure was €14 868.20 vs €9364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. ConclusionsComorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.

Impacto económico de la insuficiencia cardiaca según la influencia de la insuficiencia renal

Introduction and objectivesTo evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. MethodsObservational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of kidney failure. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. ResultsThe study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was €10 711.40. The corrected cost in the presence of kidney failure was €14 868.20 vs €9364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. ConclusionsComorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.Full English text available from: www.revespcardiol.org/en

The Comparative Efficiency of Public and Private Power Plants in Pakistan’s Electricity Industry

This study estimates a cost function for fossil fuel-based electricity generating plants operating in Pakistan during 2006–11. It employs a six-year panel dataset for 31 plants to estimate the cost function parameters. In the absence of any current evidence on comparative cost performance, the study’s attempt to document the economic efficiency of power plants in a large electricity sector is an important contribution to the literature. We find that on average, private nonutility plants (IPPs) are about 17 years younger than utility-owned plants and that the average capacity utilization, as measured by load factor, is higher for private IPPs than for public plants. After controlling for observables, the results show that, for a large part of the system, private plants produce electricity at a lower unit fuel cost than utility-owned public plants. The low efficiency of public plants is likely a result of the lack of operational maintenance and routine repairs. We find that the average fuel price (PRs per MMBTU) is lower for public plants and utility-owned private plants compared to nonutility-owned private plants which is mainly due to the composition of the fuel mix used for power generation. We also find that (i) the partial effect of fuel price changes on the average unit cost is higher for private plants than for public plants and (ii) on average, private plants use relatively expensive fuels compared to public plants. On an average fuel cost comparison, the private sector plants may be better base load plants than public sector plants, though the private sector plants may not be being used as base load plants because of the higher tariffs they change.

Variability in costs across hospital wards. A study of Chinese hospitals.

IntroductionAnalysts estimating the costs or cost-effectiveness of health interventions requiring hospitalization often cut corners because they lack data and the costs of undertaking full step-down costing studies are high. They sometimes use the costs taken from a single hospital, sometimes use simple rules of thumb for allocating total hospital costs between general inpatient care and the outpatient department, and sometimes use the average cost of an inpatient bed-day instead of a ward-specific cost.PurposeIn this paper we explore for the first time the extent and the causes of variation in ward-specific costs across hospitals, using data from China. We then use the resulting model to show how ward-specific costs for hospitals outside the data set could be estimated using information on the determinants identified in the paper.MethodologyWard-specific costs estimated using step-down costing methods from 41 hospitals in 12 provinces of China were used. We used seemingly unrelated regressions to identify the determinants of variability in the ratio of the costs of specific wards to that of the outpatient department, and explain how this can be used to generate ward-specific unit costs.FindingsWard-specific unit costs varied considerably across hospitals, ranging from 1 to 24 times the unit cost in the outpatient department — average unit costs are not a good proxy for costs at specialty wards in general. The most important sources of variability were the number of staff and the level of capacity utilization.Practice ImplicationsMore careful hospital costing studies are clearly needed. In the meantime, we have shown that in China it is possible to estimate ward-specific unit costs taking into account key determinants of variability in costs across wards. This might well be a better alternative than using simple rules of thumb or using estimates from a single study.

Economic analysis of a stand-alone reverse osmosis desalination unit powered by photovoltaic for possible application in the northwest coast of Egypt

The availability of fresh water and energy is the key factor for the development of many countries particularly those of over-populated arid areas. Potable water supply shortage and recent technological development have led to wider application of conventional, and yet advanced saline/brackish water desalination plants. Today, desalination methods require large amounts of energy, which is costly both in environmental pollution and in money terms. This study defines the main economic parameters used in estimation of desalination costs and limitation of the stand-alone, small size SWRO plants powered by photovoltaic (PV) at the northwest coast of Egypt. Moreover, a techno-economic study is made to estimate the actual cost of m3/fresh water production on real field measurements. All cost estimates are based on the prevailing prices during 2012–2013. The average unit cost of desalted water with the desalination unit powered by PV battery is 9.3–5.6 LE/m3, which is very high, but when using the unit with battery, the cost is reduced to 2.3–1.7 LE/m3 by increasing working hours to 24 h. Economical strategies should be developed for more reduction in cost, taking into account all phases from site selection and design to operation and maintenance and most importantly increasing the local manufacturing.

Monitoring the Size and Protagonists of the Drug Market: Combining Supply and Demand Data Sources and Estimates

The size of the illicit drug market is an important indicator to assess the impact on society of an important part of the illegal economy and to evaluate drug policy and law enforcement interventions. The extent of illicit drug use and of the drug market can essentially only be estimated by indirect methods based on indirect measures and on data from various sources, as administrative data sets and surveys. The combined use of several methodologies and data sets allows to reduce biases and inaccuracies of estimates obtained on the basis of each of them separately. This approach has been applied to Italian data. The estimation methods applied are capture-recapture methods with latent heterogeneity and multiplier methods. Several data sets have been used, both administrative and survey data sets. First, the retail dealer prevalence has been estimated on the basis of administrative data, then the user prevalence by multiplier methods. Using information about behaviour of dealers and consumers from survey data, the average amount of a substance used or sold and the average unit cost have been estimated and allow estimating the size of the drug market. The estimates have been obtained using a supply-side approach and a demand-side approach and have been compared. These results are in turn used for estimating the interception rate for the different substances in term of the value of the substance seized with respect to the total value of the substance to be sold at retail prices.

STRATEGY TO INCREASE THE FARM COMPETITIVENESS

Italy’s wine-growing production structure is highly pulverized. So, for many wine-growing farms lowering the production cost represents the only way of gaining a competitive advantage. Production at average unit costs lower than competitors allows to improve profitability. Among farming operations, winter pruning and tying of productive vine-branches require a high human labor. For this reason the paper presents the results of research conducted on a sample of Sicilian wine-producing farms in order to study the cost-effectiveness to make the pruning and the subsequent ligation of productive branches with tools that facilitate the work. The economic analysis, after the determination of minimum optimum size, shows that the investment is suitable for both large or small farms. This denotes how the process innovation could represent a way to achieve a cost leadership and improve profit margin.

Trauma center performance evaluation based on costs

In 2000, more than 50 million Americans were treated in hospitals following injury, with costs estimated at $80 billion, yet no performance indicator based on costs has been developed and validated specifically for acute trauma care. This study aimed to describe how data on costs have been used to evaluate the performance of acute trauma care hospitals. A systematic review using MEDLINE, EMBASE, Web of Science, The Cochrane Library, CINAHL, TRIP, and ProQuest was performed in December 2012. Cohort studies evaluating hospital performance for the treatment of injury inpatients in terms of costs were considered eligible. Two authors conducted the screening and the data abstraction independently using a piloted electronic data abstraction form. Methodological quality was evaluated using seven criteria from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Downs and Black tool. The search retrieved 6,635 studies, of which 10 were eligible for inclusion. Nine studies were conducted in the United States and one in Europe. Six studies used patient charges as a proxy for patient costs, of which four used cost-to-charge ratios. One study estimated costs using average unit costs, and three studies were based on the real costs obtained from a hospital accounting system. Average costs per patient in 2013 US dollar varied between 2,568 and 74,435. Four studies (40%) were considered to be of good methodological quality. Studies evaluating the performance of trauma hospitals in terms of costs are rare. Most are based on charges rather than costs, and they have low methodological quality. Further research is needed to develop and validate a performance indicator based on inpatient costs that will enable us to monitor trauma centers in terms of resource use. Systematic review, evidence, level III.