Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials

作     者：Taira, DA Seto, TB Siegrist, R Cosgrove, R Berezin, R Cohen, DJ 

作者机构：Beth Israel Deaconess Med Ctr Div Cardiovasc Harvard Clin Res Inst Dept Med Boston MA 02215 USA Harvard Univ Sch Med Boston MA USA Harvard Univ Sch Publ Hlth Dept Hlth Policy & Management Boston MA 02115 USA Hawaii Med Serv Assoc Honolulu HI USA Queens Med Ctr Honolulu HI USA 

出 版 物：《AMERICAN HEART JOURNAL》 (美国心脏杂志)

年 卷 期：2003年第145卷第3期

页      面：452-458页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Santa Clara American Heart Association, AHA 

主　　题：血管成形术 经腔 经皮冠状动脉/经济学 心脏外科手术/经济学 冠状动脉分流术/经济学 冠心病/外科学 冠心病/治疗 费用效益分析 成本及成本分析/方法 卫生保健费用 医院收费 医院费用 回顾性研究 支架/经济学 治疗 临床研究性/经济学 女(雌)性 人类 男(雄)性 中年人 

摘      要：Background In reporting economic evaluations of clinical trials, results are often stated without a description of the methodology used to derive the cost estimates. We compared methods for measuring costs from multicenter clinical trials to determine the extent to which the methodology affects results., Methods Patient-level data (n = 1849) from,3 multicenter clinical trials of percutaneous coronary revascularization were used to compare 4,methods of estimating costs: 1) hospital charges;2) hospital charges converted to costs by use of hospital-level cost-to-charge ratios;3) hospital charges converted to costs by use of department-level cost-to-charge ratios;4) itemized catheterization laboratory costs with nonprocedural hospital costs generated from department-level cost-to-charge ratios. Results The method used to approximate costs did not affect the main results of the economic comparisons for any of the trials. The magnitude of the cost estimates and the cost differences between treatment groups varied considerably by method, however. Charges were approximately twice as high as hospital cost estimates. At the patient level, costs generated by use of method 1 were within 10% of those generated by use of method 4 for only 5% of patients, compared with 34% and 22% of patients with methods 2 and 3, respectively. Only method 3 produced estimates of between-group cost differences that were consistently within $500 of the reference standard. Conclusion Cost estimates derived from clinical trials in the cardiovascular arena vary substantially according to accounting methodology. Thus, in reporting the results of economic analyses, a detailed description of cost derivation is necessary, particularly when the absolute magnitude of the cost estimates is important to clinical decision-making or policy-level recommendations. For the purposes of group-level comparisons, conversion of hospital charges to costs on the basis of department-level cost-to-charge ratios appears to