Micro-costing Study Research Articles

Efficiency of HIV services in Nigeria: Determinants of unit cost variation of HIV counseling and testing and prevention of mother-to-child transmission interventions.

BackgroundLike most countries with a substantial HIV burden, Nigeria continues to face challenges in reaching coverage targets of HIV services. A fundamental problem is stagnated funding in recent years. Improving efficiency is therefore paramount to effectively scale-up HIV services. In this study, we estimated the facility-level average costs (or unit costs) of HIV Counseling and Testing (HCT) and Prevention of Mother-to-Child Transmission (PMTCT) services and characterized determinants of unit cost variation. We investigated the role of service delivery modalities and the link between facility-level management practices and unit cost variability along both services’ cascades.MethodsWe conducted a cross-sectional, observational, micro-costing study in Nigeria between December 2014 and May 2015 in 141 HCT, and 137 PMTCT facilities, respectively. We retrospectively collected relevant input quantities (personnel, supplies, utilities, capital, and training), input prices, and output data for the year 2013. Staff costs were adjusted using time-motion methods. We estimated the facility-level average cost per service along the HCT and PMTCT service cascades and analyzed their composition and variability. Through linear regressions analysis, we identified aspects of service delivery and management practices associated with unit costs variations.ResultsThe weighted average cost per HIV-positive client diagnosed through HCT services was US$130. The weighted average cost per HIV-positive woman on prophylaxis in PMTCT services was US$858. These weighted values are estimates of nationally representative unit costs in Nigeria. For HCT, the facility-level unit costs per client tested and per HIV-positive client diagnosed were US$30 and US$1,364, respectively; and the median unit costs were US$17 and US$245 respectively. For PMTCT, the facility-level unit costs per woman tested, per HIV-positive woman diagnosed, and per HIV-positive woman on prophylaxis were US$46, US$2,932, and US$3,647, respectively, and the median unit costs were US$24, US$1,013 and US$1,448, respectively. Variability in costs across facilities was principally explained by the number of patients, integration of HIV services, task shifting, and the level of care.DiscussionOur findings demonstrate variability in unit costs across facilities. We found evidence consistent with economies of scale and scope, and efficiency gains in facilities implementing task-shifting. Our results could inform program design by suggesting ways to improve resource allocation and efficiently scale-up the HIV response in Nigeria. Some of our findings might also be relevant for other settings.

Incremental treatment costs for HIV-infected women initiating antiretroviral therapy during pregnancy: A 24-month micro-costing cohort study for a maternal and child health clinic in Kenya.

BackgroundTo date, little information exists on the costs of providing antiretroviral therapy (ART) within maternal and child health (MCH) clinics in Kenya. The main objective of this analysis was to estimate the annual incremental cost of providing ART within a MCH clinic for adult women initiated on ART during pregnancy over the first one and two years on treatment. The study site was the District Hospital in Kericho, Kenya.MethodsA micro-costing approach from the provider’s perspective, based on a retrospective review of patient medical records, was used to evaluate incremental costs of care (2012 USD). Cost per patient in two cohorts were evaluated: the MCH clinic group comprised of adult women who initiated ART at the site’s MCH clinic during pregnancy between 2008–2011; and for comparison, the ART clinic group comprised of adult, non-pregnant women who initiated ART at the site’s ART clinic during 2008–2011. The two groups were matched on age and baseline CD4 count at initiation. Retention at year one/two on ART was defined as having completed a clinic visit at 365/730 days on ART +/- 90 days.ResultsFor patients defined as retained in care at year one, average incremental costs per patient were $234 for the MCH clinic group (median: 215; IQR: 186, 282) and $292 in the ART clinic group (median: 227; IQR: 178, 357). ARV and laboratory costs were less on average for the MCH clinic group compared to the ART clinic group (due to lower cost regimens and fewer tests), while personnel costs were higher for the MCH clinic group.ConclusionsThe annual incremental cost per patient of providing ART were similar in the two clinic settings in 2012. With shifts in recommended ARV regimens and lab monitoring over time, annual costs of care (using 2016 USD unit costs) have remained relatively constant in nominal terms for the MCH clinic group but have fallen substantially for the ART clinic group (from nominal $292 in 2012 to nominal $227 in 2016).

Borderline personality disorder: resource utilisation costs in Ireland.

Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs. This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty. Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18-65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million. There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.

Healthcare resource use and attributable cost of Clostridium difficile infection: a micro-costing analysis comparing first and recurrent episodes.

Accurate and sufficiently detailed data on the economic burden of Clostridium difficile infection (CDI) are lacking. We performed a micro-costing study to determine the health resource utilization of patients with a first episode of CDI (fCDI) and those with a recurrent episode of CDI (rCDI). Forty-five adult and paediatric inpatients with rCDI were matched by age, sex and date of diagnosis with control patients with fCDI. Total length of hospital stay, length of stay in the ICU and several cost parameters differentiated into fixed and variable components were measured and compared across both groups. The mean total length of stay for rCDI patients was 33 days (95% CI 19-46) compared with 17 days (95% CI 12-21) for fCDI patients; P = 0.0259. ICU length of stay was also longer for rCDI patients than for fCDI patients (mean 2.5 versus 0.7 days). Mean total variable costs for fCDI and rCDI were £2382 (95% CI 1750-3014) and £4683 (95% CI 3051-6311), respectively; P = 0.009. Mean fixed costs for fCDI and rCDI were £10 328 (95% CI 7555-13 101) and £26 438 (95% CI 16 135-36 742), respectively; P = 0.003. Mean total costs for fCDI and rCDI were £12 710 (95% CI 9652-15 769) and £31 121 (95% CI 19 792-42 447), respectively; P < 0.002. The healthcare resource use and financial burden attributable to CDI is significant. Most excess cost is driven by additional length of hospital stay. These costs may have been underestimated in previous studies that have not accounted for several difficult-to-measure parameters or have used averaged tariff-based estimates.

Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service.

In an environment of limited health care resources, it is crucial for health care systems which provide blood transfusion to have accurate and comprehensive information on the costs of transfusion, incorporating not only the costs of blood products, but also their administration. Unfortunately, in many countries accurate costs for administering blood are not available. Our study aimed to generate comprehensive estimates of the costs of administering transfusions for the UK National Health Service. A detailed microcosting study was used to cost two key inputs into transfusion: transfusion laboratory and nursing inputs. For each input, data collection forms were developed to capture staff time, equipment, and consumables associated with each step in the transfusion process. Costing results were combined with costs of blood product wastage to calculate the cost per unit transfused, separately for different blood products. Data were collected in 2014/15 British pounds and converted to US dollars. A total of 438 data collection forms were completed by 74 staff. The cost of administering blood was $71 (£49) per unit for red blood cells, $84 (£58) for platelets, $55 (£38) for fresh-frozen plasma, and $72 (£49) for cryoprecipitate. Blood administration costs add substantially to the costs of the blood products themselves. These are frequently incurred costs; applying estimates to the blood components supplied to UK hospitals in 2015, the annual cost of blood administration, excluding blood products, exceeds $175 (£120) million. These results provide more accurate estimates of the total costs of transfusion than those previously available.

Cost estimate and budget impact analysis of implementing the new guidelines for management of hepatitis C virus in China: a micro-costing study

BackgroundNew international guidelines, local experts, and the WHO China Office recommend a standardised package of treatment for hepatitis C virus, using sofosbuvir as the direct-acting antiviral drug due to its high efficacy and ease of use. Unlike currently available injection-based treatments (interferon or peginterferon-based therapy), sofosbuvir is taken orally, with improved treatment adherence expected. However, sofosbuvir is currently not in the market in China, and would be unaffordable to many patients. We aimed to assess the average cost of care for chronic hepatitis C virus in China with current injection-based therapies compared with the cost of sofosbuvir-based treatment, and the budget impact of introducing new guidelines for treatment of chronic hepatitis C virus with sofosbuvir. MethodsA micro-costing multilevel and multicentric study collecting data on all care activities for chronic hepatitis C virus was designed and sent to a random sample of tertiary provincial hospitals in the east, central, west, and northwest regions of China. Snowball sampling was utilised to contact tertiary city hospitals, secondary city hospitals, and secondary county hospitals. 16 hospitals filled out the survey of 16 invited to take part. Average cost per patient per year was assessed; because large standard deviation in costs indicated large variations in the sample, we weighted costs by the number of patients with chronic hepatitis C virus (as a proportion of all patients in the country). Because there is no current price for sofosbuvir, we used a cost-effective price compared with the current regimen of peginterferon in China, the price of sofosbuvir in India, and the price of sofosbuvir in Brazil. We conducted a one-way sensitivity analysis on weights and treatment drug cost, and a computer-based budget impact analysis. FindingsThe average yearly cost for each patient (weighted by patient load per hospital) was ¥45 700. The cost of the standard package regimen (using the cost-effective sofosbuvir price) was ¥31 700 per patient, although this fell to ¥11 400 using the current price of sofosbuvir in India and rose to ¥75 000 using the price of sofosbuvir in Brazil. Pre-assessment and monitoring costs were much higher than the standard package (more than four times). Patients paying all costs of care paid ¥45 700 per year under the current practice, ¥31 748 under the standardised care using the cost-effective sofosbuvir price, and ¥11 360 using the Indian sofosbuvir price. These costs compared with the threshold for catastrophic health expenditure of ¥20 167 for average households, ¥28 844 for urban households, and ¥9892 for rural households, suggesting that rural patients cannot afford full chronic hepatitis C care. If a public payer were to cover all care costs for patients with hepatitis C virus in China (100 000 individuals), it would cost ¥4·6 billion for current care practices (including ¥4·1 billion for currently used antiviral treatments only) and ¥1·1 billion for standardised care (¥1·0 billion for standard-package antiviral treatments only), equivalent to 0·48% of the Ministry of Finance health expenditure for 2013 for the current package and 0·12% for the standard package. The total cost after 5 years would be ¥22·9 billion for the current package (including ¥20·4 billion for antiviral drugs) and ¥5·7 billion for the standard package (including ¥5·1 billion standard package for antiviral drugs). Based on the one-way sensitivity analysis, the sofosbuvir regimen price was the biggest cost-driver, followed by the target population. InterpretationAt present, care for chronic hepatitis C virus is unaffordable for Chinese patients. Considering that current treatment costs are unaffordable for patients, and that better and curative therapies are available that could save lives and resources in the long run, it is reasonable for China to consider funding or reimbursing standardised care for hepatitis C virus with evidence-based therapies. FundingWorld Health Organization China.

PGI6 - How does high meld score increases total expenditure on health system? A micro-costing prospective cohort study

PGI6 - How does high meld score increases total expenditure on health system? A micro-costing prospective cohort study

Microcosting Study of Rituximab Subcutaneous Injection Versus Intravenous Infusion

PurposeThe goal of this study is to identify and compare all direct costs of intravenous and subcutaneous rituximab given to patients with diffuse large B-cell lymphoma in the Netherlands. MethodsUsing a prospective, observational, bottom-up microcosting study, we collected primary data on the direct medical costs of the preparation, administration, and acquisition of rituximab. Drug costs and costs of drug wastage, labor costs, material costs, and outpatient costs were identified using standardized forms, structured using prices from official pricelists, and compared for the intravenous and subcutaneous forms of rituximab. FindingsMeasurements were taken on 53 rituximab administrations (33 intravenous and 20 subcutaneous) and on 13 rituximab preparation (7 intravenous and 6 subcutaneous). The mean total costs were €2176.77 for the intravenous infusion and €1911.09 for the subcutaneous injection. The estimated difference of €265.17 (95% CI, €231.99–`€298.35) per administration was mainly attributable to differences in time spent in the chemotherapy unit, related outpatient costs, drug wastage, and drug costs. ImplicationsRituximab administered in the form of subcutaneous injection is less costly than its intravenous form. With their equal effectiveness taken into account, subcutaneous rituximab administration can result in significant savings when transferred to the total diffuse large B-cell lymphoma population in the Netherlands.

Costs of integrating cervical cancer screening at an HIV clinic in Kenya.

To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya. A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening. There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening). Integrating cervical cancer screening into HIV clinics would be cost-saving from a societal perspective compared with non-integrated screening. These findings could be used in cost-effectiveness analyses to assess incremental costs per clinical outcome in an integrated setting.

The cost of inpatient management of heart failure patients: a microcosting study in the Irish healthcare setting.

To formally assess the resource use and cost of the inpatient treatment of heart failure (HF) from the health-payer's perspective. In addition, to compare costs in our cohort to (a) locally derived patient-level costs (PLC) and (b) national costs as per disease-related group (DRG). Study population Demographics and resource utilisation data were obtained from a cohort of 30 patients (57% male, mean age 70years) admitted into a single tertiary centre with heart failure. Patients were identified retrospectively. Costing A microcosting approach was used to examine admission costs that were compared to PLC costs and DRG costs. Main outcome measure The bootstrap estimation was used to determine mean inpatient length of stay (LOS) with standard deviation (±SD) and mean costs ±SD. The bootstrapped mean cost per HF episode was €10,474±2478. The major cost drivers were ward stay (mean cost €6068±€1681): laboratory costs (€1373±79) and cath lab costs (€1415±729). HF was more expensive to manage in patients ≤65years (€18,930±5546) compared to those aged over 65years (€6209±1732); p=0.001. No significant difference was found in managing heart failure in males (€11,035±3564) versus females (€9629±3294), p=0.69. DRG costing frequently over or underestimated the admission cost. PLC costs were similar to microcosting derived costs. The bootstrapped mean LOS per HF episode was 15.7days±3.4. This study confirms that heart failure is a costly condition and that inpatient stay is the major cost driver. HF was significantly more expensive to manage in patients ≤65years compared to those aged over 65years. DRG costing frequently over or underestimated the admission cost. Patient-level costs and microcosting are more accurate methods of costing inpatient HF admissions. To our knowledge, this is the first study of the cost of the inpatient treatment of HF within the context of the Irish healthcare setting.

Multicenter prospective micro-costing study evaluating mandibular free-flap reconstruction

Free-flap mandibular reconstruction is a highly specialized procedure associated with severe complications necessitating re-interventions and re-hospitalizations. This surgery is expensive in terms of health workers' time, equipment, medical devices and drugs. Our main objective was to assess the direct hospital cost generated by osseocutaneous free-flap surgery in a multicentric prospective micro-costing study. Direct medical costs evaluated from a hospital perspective were assessed using a micro-costing method from the first consultation with the surgeon until the patient returns home, thus confirming the success or failure of the free-flap procedure. The mean total cost for free-flap intervention was 34,009€ (5151-119,604€), the most expensive item being the duration of hospital bed occupation, representing 30-90% of the total cost. In the event of complications, the mean cost increased by 77.3%, due primarily to hospitalization in ICU and the conventional unit. This surgery is effective and provides good results but remains highly complex and costly.

A time-and-motion approach to micro-costing of high-throughput genomic assays.

Genomic technologies are increasingly used to guide clinical decision-making in cancer control. Economic evidence about the cost-effectiveness of genomic technologies is limited, in part because of a lack of published comprehensive cost estimates. In the present micro-costing study, we used a time-and-motion approach to derive cost estimates for 3 genomic assays and processes-digital gene expression profiling (gep), fluorescence in situ hybridization (fish), and targeted capture sequencing, including bioinformatics analysis-in the context of lymphoma patient management. The setting for the study was the Department of Lymphoid Cancer Research laboratory at the BC Cancer Agency in Vancouver, British Columbia. Mean per-case hands-on time and resource measurements were determined from a series of direct observations of each assay. Per-case cost estimates were calculated using a bottom-up costing approach, with labour, capital and equipment, supplies and reagents, and overhead costs included. The most labour-intensive assay was found to be fish at 258.2 minutes per case, followed by targeted capture sequencing (124.1 minutes per case) and digital gep (14.9 minutes per case). Based on a historical case throughput of 180 cases annually, the mean per-case cost (2014 Canadian dollars) was estimated to be $1,029.16 for targeted capture sequencing and bioinformatics analysis, $596.60 for fish, and $898.35 for digital gep with an 807-gene code set. With the growing emphasis on personalized approaches to cancer management, the need for economic evaluations of high-throughput genomic assays is increasing. Through economic modelling and budget-impact analyses, the cost estimates presented here can be used to inform priority-setting decisions about the implementation of such assays in clinical practice.

A microcosting study of immunogenicity and tumour necrosis factor alpha inhibitor drug level tests for therapeutic drug monitoring in clinical practice.

Objectives. To identify and quantify resource required and associated costs for implementing TNF-α inhibitor (TNFi) drug level and anti-drug antibody (ADAb) tests in UK rheumatology practice. Methods. A microcosting study, assuming the UK National Health Service perspective, identified the direct medical costs associated with providing TNFi drug level and ADAb testing in clinical practice. Resource use and costs per patient were identified via four stages: identification of a patient pathway with resource implications; estimation of the resources required; identification of the cost per unit of resource (2015 prices); and calculation of the total costs per patient. Univariate and multiway sensitivity analyses were performed using the variation in resource use and unit costs.Results. Total costs for TNFi drug level and concurrent ADAb testing, assessed using ELISAs on trough serum levels, were £152.52/patient (range: £147.68–159.24) if 40 patient samples were tested simultaneously. For the base–case analysis, the pre-testing phase incurred the highest costs, which included booking an additional appointment to acquire trough blood samples. The additional appointment was the key driver of costs per patient (67% of the total cost), and labour accounted for 10% and consumables 23% of the total costs. Performing ELISAs once per patient (rather than in duplicate) reduced the total costs to £133.78/patient.Conclusion. This microcosting study is the first assessing the cost of TNFi drug level and ADAb testing. The results could be used in subsequent cost-effectiveness analyses of TNFi pharmacological tests to target treatments and inform future policy recommendations.

PCN54 - Costs of Cervical Cancer Screening and Diagnosis in China: A Micro-Costing Study

PCN54 - Costs of Cervical Cancer Screening and Diagnosis in China: A Micro-Costing Study

Predicting High Surgical Treatment Costs at Primary Spinal Tumor Patients

Introduction Surgical treatment cost of primary spinal tumors -due to the complexity and magnitude of the surgery- can be high. From a healthcare provider perspective being aware of those factors that influence treatment cost is essential for the best hospital resource management. However the impact of the individual patient characteristics on direct medical costs is unknown. Our objective was to identify those preoperative factors that predict a high direct cost at patients with surgically treated primary spinal tumors. Material and Methods A retrospective micro-costing study was conducted from a healthcare provider perspective. Total cost per patient resulted from the aggregation of inpatient-days costs, ICU days costs, OR time costs (surgery and anesthesiology), medication costs, blood transfusion costs and other material costs, including appropriate allocation of overheads. Patients with primary spinal tumors operated in the National Center for Spinal Disorders between 2011 and 2014 were selected. The prognostic value of ten preoperative factors (dignity, previous surgery, pathological fracture, neurological dysfunction, age, spinal level, ASA score, Charlson Comorbidity Index, BMI, tumor volume) was investigated in linear regression modelling. Results 72 surgically treated primary spinal tumor patients were included in the study. Median length of hospital stay was 12 days (3–115), the median ICU treatment was 1.4 days (0–21.7), the median OR time was 2.8 hour (0.4–20.4). Median cost per patient was 3,088.5 € (537.7 € to 21,860.6 €). In the univariate analysis only ASA score, Charlson Comorbidity Index and pathological fracture were not significantly associated with higher cost. The seven significant variables were further assessed in a multivariate model. Dignity, previous surgery, spinal level and tumor volume were associated with high cost and preoperative neurologic dysfunction showed only a trend toward significance (whole model: R=0,69, R2=0,44, df=5, F=12,34 p &lt; 0,001). Conclusion The present study identifies four predictive variables for high hospital cost related to primary spinal tumor surgery. Malignant tumors, previous surgery, sacral involvement and large tumor volume significantly increase the cost of treatment. This method of cost analysis provides useful insights for resource management in the surgical treatment of spinal tumors.

Direct costs of interferon-based and interferon-free direct-acting antiviral regimens for the treatment of chronic hepatitis C infection.

Given the increasing budget impact of Hepatitis C virus (HCV) treatment, robust real-world cost data are essential for healthcare decision-makers to evaluate and understand the costs and benefits of these treatments. To determine the direct cost of treating HCV infection in a hospital-based ambulatory care setting in Ireland based on available data from the Irish national hepatitis C treatment registry. A microcosting study of the direct costs of patients with hepatitis C treated with interferon-based and interferon-free direct-acting antiviral regimens was conducted. Attendance at the outpatient clinic for clinical assessment, the quantity of resources used per patient, the medication prescribed and the identification and timing of staff involvement was measured and combined to establish a mean cost of treatment per patient and a cost per sustained virological response (SVR). One hundred and sixty-eight patients were included in the analysis; 119 treated with interferon-based direct-acting antiviral regimens and 47 treated with interferon-free regimens. The mean costs of treatment with the interferon-based regimens per patient were €38 286 (95% CI €35 305-€41 061). The cost per SVR was €62 457. The mean cost of treatment with interferon-free regimens per patient was €55 734 (95% CI €50 906-€60 880). The cost per SVR was €81 873. Real-world cost data provide valuable information to enhance reimbursement decisions. While the direct costs associated with hepatitis C treatment in Ireland are substantial, it is reasonable to expect that the mean cost of treatment and the cost per SVR will reduce as patients with less advanced disease are treated with interferon-free therapies.

A Microcosting Study Of Radiation Therapy In Localized Prostate Cancer Patients In A Hungarian Tertiary Oncology Center

A Microcosting Study Of Radiation Therapy In Localized Prostate Cancer Patients In A Hungarian Tertiary Oncology Center

Hepatitis C in the era of direct-acting antivirals: real-world costs of untreated chronic hepatitis C; a cross-sectional study.

BackgroundRecent advances in Hepatitis C therapeutics offer the possibility of cure but will be expensive. The cost of treatment may be partially offset by the avoidance of advanced liver disease. We performed a micro-costing study of the ambulatory healthcare utilisation of patients with Hepatitis C supplemented with inpatient diagnosis related group costs.MethodsThe staff utilisation costs associated with a Hepatitis C ambulatory visit were measured and combined with the costs of investigations to establish a mean cost per consultation. An annualised estimate of cost was produced by multiplying this by the number of consultations accessed, stratified by degree of liver impairment. Inpatient costs were established by identifying the number of inpatient episodes and multiplying by Irish diagnosis related group costs. Non-parametric bootstrapping was performed to derive mean and 95%CI values.ResultsTwo hundred and twenty-five patients were identified. The cost of an outpatient medical review was €136 (€3.60 SD). The cost of a Hepatitis C nursing review was €128 (€7.30 SD). The annual mean costs of care were as follows (95%CI): Mild €398 (€336, €482), Moderate €417(€335, €503), Compensated cirrhosis €1790 (€990, €3164), Decompensated cirrhosis €8302 (€3945, €14,637), Transplantation Year 1 €137,176 (€136,024, €138,306), Transplantation after Year 1 €5337 (€4942, €5799), Hepatocellular carcinoma €21,992 (€15,222, €29,467), Sustained virological response €44 (€16, €73).ConclusionsThe direct medical cost associated with Hepatitis C care in Ireland is substantial and increases exponentially with progression of liver disease. The follow-up costs of patients with a sustained virological response in this cohort were low in comparison to patients with chronic infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1208-1) contains supplementary material, which is available to authorized users.

The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units

ObjectivesTo estimate the daily cost of intensive care unit (ICU) stays via micro-costing. MethodsA multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospital's perspective (reference year 2009) based on unitary cost data. ResultsOne hundred and four patients were included (mean age: 62.3±14.9 years, mean SAPS II: 51.5±16.1, mean SOFA on the study day: 6.9±4.3). Over 24hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32±05:00h. The total daily cost per patient was €1425±€520 (95% CI=€1323 to €1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€842±€521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r=0.271, P=0.006) and the bedside-time given by caregivers (r=0.716, P<0.0001). ConclusionThe average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources.

Direct costs of radiotherapy for rectal cancer: a microcosting study.

BackgroundRadiotherapy provides significant benefits in terms of reducing risk of local recurrence and death from rectal cancer. Despite this, up-to-date cost estimates for radiotherapy are lacking, potentially inhibiting policy and decision-making. Our objective was to generate an up-to-date estimate of the cost of traditional radiotherapy for rectal cancer and model the impact of a range of potential efficiency improvements.MethodsMicrocosting methods were used to estimate total direct radiotherapy costs for long- (assumed at 45-50 Gy in 25 daily fractions over a 5 week period) and short-courses (assumed at 25 Gy in 5 daily fractions over a one week period). Following interviews and on-site visits to radiotherapy departments in two designated cancer centers, a radiotherapy care pathway for a typical rectal cancer patient was developed. Total direct costs were derived by applying fixed and variable unit costs to resource use within each care phase. Costs included labor, capital, consumables and overheads. Sensitivity analyses were performed.ResultsRadiotherapy treatment was estimated to cost between €2,080 (5-fraction course) and €3,609 (25-fraction course) for an average patient in 2012. Costs were highest in the treatment planning phase for the short-course (€1,217; 58% of total costs), but highest in the radiation treatment phase for the long-course (€1,974: 60% of total costs). By simultaneously varying treatment time, capacity utilization rates and linear accelerator staff numbers, the base cost fell by 20% for 5-fractions: (€1,660) and 35% for 25-fractions: (€2,354).ConclusionsTraditional radiotherapy for rectal cancer is relatively inexpensive. Moreover, significant savings may be achievable through service organization and provision changes. These results suggest that a strong economic argument can be made for expanding the use of radiotherapy in rectal cancer treatment.