MedUni Vienna: Differing calculation methods hinder cost comparisons between public health care systems across the EU

To make optimal funding decisions in European public health and social care systems, valid cost data are indispensable. Standardized information that captures resource use from a cost accounting perspective and goes beyond reimbursement lists is currently missing in Austria. In a study recently published in the Top Journal Value in Health, a team led by Judit Simon, Head of the Department of Health Economics at the Medical University of Vienna (Center for Public Health), compared for the first time national and international costing methods based on the unit cost of a general practitioner consultation in Austria.

Public healthcare systems across Europe are increasingly burdened by the expenses of chronic and mental diseases as well as multi-morbidity. At the same time, it is impossible to compare these cost consequences or conduct robust health economic evaluations across sectors or internationally due to the currently lacking gold standard for cost calculation methods.

Since 2018, the EU-funded project PECUNIA aims to develop standardized and validated costing and outcome assessment measures for optimised healthcare provision in the EU. PECUNIA is coordinated by Judit Simon, Head of Department of Health Economics (DHE), Center for Public Health at the Medical University of Vienna. As part of the PECUNIA project, a team around Judit Simon and Susanne Mayer has now published a systematic comparison of differing calculation methods and their impact on national unit cost estimates.

The cost of a general practitioner consultation in Austria served as the case study. Six differing costing methods, three Austrian approaches and three established approaches from Germany, the Netherlands and the United Kingdom, were applied.  The three Austrian costing methods included a review of information in the publicly-accessible, annually updated DHE Unit Cost Online Database which synthesizes previously published unit cost estimates from Austrian health economic evaluations;  the published Physicians’ Chambers’ price recommendations; as well as data retrieved from tariff catalogues of different sickness funds. The study showed that for year 2015, mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach and the Physicians’ Chambers’ price recommendations. The Dutch top-down and the UK bottom-up costing methods yielded estimates between €25.3 and €29.8. Overall variation reached 173%.

The study highlighted that unit cost estimates depend not only on the available data, but very much also on the applied calculation method. Simon: “Our results demonstrate that it is crucial to standardize unit cost calculation methods across sectors and countries in order to generate comparable cost data and therewith increase the efficiency of health care systems. The PECUNIA project aims to develop such harmonized methods to estimate unit costs for selected services and ultimately make them publicly available.”

Service: Value in Health

Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations. Susanne Mayer, Claudia Fischer, Ingrid Zechmeister-Koss, Herwig Ostermann, Judit Simon.

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