How to determine cost data from patient- completed questionnaires?
How to determine cost data from patientcompleted questionnaires? Dr. Thomas Reinhold UNIVERSITÄTSMEDIZIN BERLIN Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN Medical supply processes Cost of the treatment, measurable Benefits of treatment options in monetary terms: Measurable in monetary terms: • Direct costs • Direct benefit • Indirect costs • Indirect benefit Non-monetary measure: Non-monetary measure: (Intangible costs) Morbidity parameters Mortality (Intangible benefits effects) UNIVERSITÄTSMEDIZIN BERLIN Direct and Indirect costs - definition Direct costs …can be traced directly to a cost object such as a disease or a treatment. In health economics direct costs can be distinguished in two categories: § direct medical costs (costs include consumed healthcare resources) § direct non-medical costs (typical are patients out-of-pocket expenses, for instance travel costs to the hospital) Indirect costs (costs that affect the national GDP) The main component of indirect costs are costs due to time lost at work due to illness or death, i.e. production losses. Indirect costs of a disease that could be averted by an intervention are considered in cost-effectiveness analysis or cost-utility analysis when performing the analysis from the societal perspective. UNIVERSITÄTSMEDIZIN BERLIN Direct and Indirect costs - examples – Direct medical costs • • • • • • • drugs physician visits Inpatient stays adjuvants and remedies rehabilitation services Patients expenditures … - Direct non-medical costs • patients expenditures on travel • home help • … UNIVERSITÄTSMEDIZIN BERLIN – Indirect costs • incapacity to work • premature death • early retirement Specificity of costs • Disease related costs – Costs directly associated to a specific disease – e.g. antithrombotic drugs for patients after myocardial infarction – Best for evaluation of a specific treatment • Overall costs – Complete health care costs independent from a specific disease – e.g. costs for all medications (including e.g. pain drugs) for patients after myocardial infarction UNIVERSITÄTSMEDIZIN BERLIN Patient questionnaires • a planned set of questions used to collect data • It can be sent to the respondents by mail or used as the basis of a personal interview • The biggest problem is to keep the size of the questionnaire small enough in order to keep a high response rate • It is also desirable to couch the questions so that the responses can be easily categorized and the results computerized. Be aware the response rate and the danger of patient selection! UNIVERSITÄTSMEDIZIN BERLIN Retrospective vs. Prospective design today Retrospective design Prospective design „What ressources you „Please document what is your consumed during the last ressource consumption during the X months?“ next X months!“ • • • Danger of recall bias Differential recall bias Simple, easy and cheaply UNIVERSITÄTSMEDIZIN BERLIN • • • • More Comprehensive More expensive Close meshed Longer waiting time for completed questionnaires time General comments • Ways of cost-determination differ deeply depending on the structure of health care system! • 2 principal approaches: – Bottom-up cost approach: • method of making cost-estimates for every disease/treatment by summarizing single costs-components to provide a total cost estimate. • Appropriate method to measure costs from patient-completed questionnaires • ∑(Number of single ressource units consumed * units costs) – Opposite: Top-down cost approach: • Based on total costs associated with a disease/treatment the single units costs were determined UNIVERSITÄTSMEDIZIN BERLIN Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN What we do… How we (Charité University Medical Center) extract costs from patient completed questionnaires? What costs patients suffering from chronic low back pain occurred during the last months? UNIVERSITÄTSMEDIZIN BERLIN Direct Costs – overview Germany Year 2010 Inpatient Treatment Medication Outpatient Treatment UNIVERSITÄTSMEDIZIN BERLIN Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN Inpatient treatments • Ideally the patient provides detailed information on – – – – – Medical inpatient treatments received Time the doctor (and nurses) invests for treatment and care Consumables used Medication received during hospital stay Etc. But: • Usually patient are not willing / not able to document their inpatient in such detailedness! UNIVERSITÄTSMEDIZIN BERLIN Inpatient stays 12. April to 18. April 2011 UNIVERSITÄTSMEDIZIN BERLIN 6 nights Severe pain in the lower back German DRG System • Germanys hospital treatments are paid by a case-based lump sum • Within the DRG-system the mean costs per stay are known (mean costs = 3,000 Euro) • The mean duration of hospital stay is well know (= 8.5 days) • Mean costs per hospital-day = 3,000 Euro / 8.5 days = 353 Euro • Mean inpatient costs = Number of hospital days (6 days) * 353 Euro = 2,118 Euro UNIVERSITÄTSMEDIZIN BERLIN Inpatient stays 2,118 Euro 12. April to 18. April 2011 6 nights Severe pain in the lower back Usable for adjusting of costmeasurement, but often unprecice patient-report UNIVERSITÄTSMEDIZIN BERLIN Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN Costs of Medication • Ideally the patient provides detailed information on – – – – – the manufacturer, the name of the medication the package-size the kind of application the units consumed (e.g. number of pills) • Drug costs = number of pills * Cost per pill UNIVERSITÄTSMEDIZIN BERLIN German Drug Price List Cost per pill = Total package costs / number of pills included UNIVERSITÄTSMEDIZIN BERLIN Costs of Medication • Ideally the patient provides detailed information on – – – – – the manufacturer, the name of the medication the package-size the kind of application the units consumed (e.g. pills) But: Usually patient are not willing / not able to document their drug usage in such detailedness! UNIVERSITÄTSMEDIZIN BERLIN Costs of Medication Ibuprofen UNIVERSITÄTSMEDIZIN BERLIN I dont know??? 20 days Drug costs using DDDs • DDD – daily defined dosis – Developed by WHO Collaborating Centre for Drug Statistics Methodology – the assumed average maintenance dose per day for a drug used for its main indication in adults – a unit of measurement that does not necessarily reflect the recommended or prescribed daily dose UNIVERSITÄTSMEDIZIN BERLIN Drug costs using DDDs 0,58 Euro = mean costs for 1 Daily defined dosis of Ibuprofen * Number of medication-days (20 days) = Expected medication costs (11.6 Euro) UNIVERSITÄTSMEDIZIN BERLIN Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN Outpatient visits • Ideally the patient provides detailed information on – – – – Medical treatments received Time the doctor invests for treatment Consumables used Etc. But: • Usually patient are not willing / not able to document their outpatient visits in such detailedness! UNIVERSITÄTSMEDIZIN BERLIN Outpatient visits UNIVERSITÄTSMEDIZIN BERLIN Outpatient visits Mean costs per visit from third party payers perspective general practitioner internist otorhinolaryngologist dermatologist naturopathic specialist psychologist nutrition specialist other specialists Provided by the German Association of Statutory Health Insurance Physicians UNIVERSITÄTSMEDIZIN BERLIN 15,09 € 32,59 € 23,42 € 14,72 € 15,09 € 32,76 € 25,00 € 21,68 € Overview § Background and Definitions § Measuring costs from Patients questionnaires § Inpatient costs § Costs on drugs § Outpatient costs § Indirect costs § Conclusion UNIVERSITÄTSMEDIZIN BERLIN Indirect costs UNIVERSITÄTSMEDIZIN BERLIN Human Capital Approach Value of humans life = value of his productivity (equates his monetary earnings) • productivity losses from early death or morbidity (indirect costs) • for society as a whole, mortality or morbidity represents a loss in national output Problems: • People who are not working for pay (e.g., homemakers, students, retirees) are valued at 0! • Implies that people with higher wages have higher social value. UNIVERSITÄTSMEDIZIN BERLIN Indirect costs If not employed – no indirect costs measurable Indirect costs = Number of days with work incapacity * Mean daily income per working day (approx. 78 Euro in Germany) UNIVERSITÄTSMEDIZIN BERLIN Conclusions • Information collected directly from patients are not comparable in precision compared to e.g. doctors reports, but are more comprehensive… • In principle, patient completed questionnaires are usable for measuring patients health care costs • To get more precise cost information secondary data use or combined data sources seem useful UNIVERSITÄTSMEDIZIN BERLIN Thanks for your attention 非常感谢您的关注 UNIVERSITÄTSMEDIZIN BERLIN
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