Leeuwerik, Anke (2019) Do the daily tariffs of hospital stay in the guidelines for economic evaluation reflect the actual costs of hospitalisation in the Netherlands? Bachelor's Project, Pharmacy.
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Abstract
BACKGROUND The Dutch guidelines for economic evaluation recommend cost-utility analysis for performing an economic evaluation. For the cost-analysis of this evaluation, the use of standard tariffs is recommended by the Dutch guideline for costing studies, when performing micro-costing studies is too time-consuming. However, the standard daily tariff for a hospital stay is only based on an unpublished micro-costing study performed on the neurology-, paediatric- and surgery unit(1). The standard daily tariff appears to be an overestimation of the price reflecting all hospital units. In addition, the uncertainty around this tariff is not mentioned in the guideline. Therefore, it is not known which extent of uncertainty has to be taken into account when using the standard daily tariff. This study aims to convert the Dutch standard daily tariff to the estimated actual costs of hospitalization. A method for estimating the actual daily tariff and its uncertainty will be researched. Thereafter, the impact of the deviation from the actual price on cost-utility analysis will be determined. In this way, the usability of the Dutch standard daily tariff will be researched. METHODS A method for estimating the actual Dutch standard daily tariff based on the more accurate UK tariffs was developed. The deviation in inpatient day price of the three units relative to all hospital units was calculated and used as a correction factor in order to calculate the actual Dutch tariff. Also, the uncertainty of this modified tariff was determined by using the deviation of the bounds of the 95% CI from the average price of the UK tariffs. The impact on the incremental cost-utility ratio (ICUR) of the modified standard tariff was researched by incorporating this new tariff in a Dutch cost-utility study, using the Dutch standard daily tariffs. In addition, a sensitivity analysis was performed by using the bounds of the 95% CI in the cost-utility analysis and researching the outcomes on the ICUR. RESULTS A comparison between the UK average costs of all hospital units and the UK neurology-, paediatric- and surgery unit showed a deviation of +34,06%. After adjustment of the Dutch standard tariff for an inpatient day with this deviation, the tariff changed from €476 to €355 (95% CI: €275-€615). This modified tariff for an inpatient day increases the ICUR of minimally invasive pancreatectomy from -€23,722 to €4,980 per QALY (sensitivity analysis: €24.054 - -€56.617 per QALY). CONCLUSION Altogether, the Dutch standard tariff for an inpatient day should be used with caution in cost-utility analysis. Based on the UK standard tariffs for a hospital stay, the three hospital units used for calculating the Dutch standard daily tariffs seems to lead to a too high estimate of the costs. In addition, the deviation of the standard tariff from the actual costs proved to have a substantial impact on the ICUR outcomes. The change of the ICUR can lead to a different position towards the willingness-to-pay (WTP) threshold and therefore can result in different policy decisions. Also, the sensitivity analysis showed a high variation in price across different hospital units. For this reason, the uncertainty based on the UK data is relevant to take into account when using the reference price.
| Item Type: | Thesis (Bachelor's Project) |
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| Supervisor name: | Postma, M.J. |
| Degree programme: | Pharmacy |
| Thesis type: | Bachelor's Project |
| Language: | English |
| Date Deposited: | 22 Jul 2019 |
| Last Modified: | 23 Jul 2019 14:02 |
| URI: | https://fse.studenttheses.ub.rug.nl/id/eprint/20387 |
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