Skip to main content Accessibility help
×
Home
Hostname: page-component-559fc8cf4f-6f8dk Total loading time: 0.505 Render date: 2021-03-05T18:26:41.360Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES

Published online by Cambridge University Press:  31 December 2018

Roslyn Prichard
Affiliation:
St Vincent’s Hospital, Faculty of Health, University of Technology Sydney
Louise Kershaw
Affiliation:
St Vincent's Hospital Sydney
Patricia M. Davidson
Affiliation:
Johns Hopkins University Baltimore, Faculty of Health University of Technology Sydney
Phillip J. Newton
Affiliation:
Western Sydney University
Stephen Goodall
Affiliation:
Centre for Health Economics Research and Evaluation, University of Technology Sydney
Christopher Hayward
Affiliation:
St Vincent's Hospital, Faculty of Health University of Technology Sydneycshayward@stvincents.com.au
Corresponding

Abstract

Objectives:

The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy.

Methods:

Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009–12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission.

Results:

The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839–$271,743), versus $270,716 (IQR $211,740–$378,482) for the institutional micro-costing (p = .08).

Conclusions:

Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional data can illuminate both the pathways to transplant referral and the hospital activity generated by patients experiencing the terminal phases of heart failure in the year before transplant, cf-VAD implant, or death.

Type
Method
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below.

Footnotes

The authors acknowledge the assistance of St Vincent's Hospital finance department and in particular Melita Howes and Lai Mun Balnave for advice and support during the study. This investigator initiated study was supported by Heartware Inc. (C.H., Salary Support for research staff), the National Health and Medical Research Council (R.P. NHMRC post graduate scholarship APP1133337 and an Australian Government research training program scholarship). None of the other authors have a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose. The authors also thank the Centre for Health Record Linkage for the data linkage and the New South Wales Ministry of Health, for the use of linked data from the admitted patient and emergency department collections (APDC/EDDC).

References

1.Kirklin, JK, Naftel, DC, Pagani, FD, et al. Seventh INTERMACS annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:14951504. doi:10.1016/j.healun.2015.10.003.CrossRefGoogle ScholarPubMed
2.Nunes, AJ, MacArthur, RGG, Kim, D, et al. A systematic review of the cost-effectiveness of long-term mechanical circulatory support. Value Health. 2016;19:494504. doi:10.1016/j.jval.2014.12.020.CrossRefGoogle ScholarPubMed
3.Kirklin, JK, Pagani, FD, Kormos, RL, et al. Eighth annual INTERMACS report: Special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36:10801086. doi:10.1016/j.healun.2017.07.005.CrossRefGoogle ScholarPubMed
4.Australian Government Department of Health. The prostheses list. www.health.gov.au/internet/main/publishing.nsf/content/health-privatehealth-prostheseslist.htm (accessed December 5, 2016).Google Scholar
5.Birks, E. The comparative use of ventricular assist devices. Tex Heart Inst J 2010;37:13.Google ScholarPubMed
6.Sahle, BW, Owen, AJ, Mutowo, MP, et al. Prevalence of heart failure in Australia: A systematic review. BMC Cardiovasc Disord. 2016;16:32. doi:10.1186/s12872-016-0208-4.CrossRefGoogle ScholarPubMed
7.Australia's Health 2014. Australian Institute of Health and Welfare 2014. 2014; (Cat. no. AUS 178):1578.Google Scholar
8.Xu, X, Grossetta Nardini, HK, Ruger, J. Micro-costing studies in the health and medical literature: Protocol for a systematic review. Syst Rev. 2014;3:47. doi:10.1136/bmj.38737.607558.80.CrossRefGoogle ScholarPubMed
9.Frappier, J, Tremblay, G, Charny, M, Cloutier, LM. Costing bias in economic evaluations. J Med Econ. 2015;18:596599. doi:10.3111/13696998.2015.1033423.CrossRefGoogle ScholarPubMed
10.Tan, SS, Bakker, J, Hoogendoorn, ME, et al. Direct cost analysis of intensive care unit stay in four European countries: Applying a standardized costing methodology. Value Health. 2012;15:8186. doi:10.1016/j.jval.2011.09.007.CrossRefGoogle ScholarPubMed
11.Alvin, MD, Miller, JA, Lubelski, D, et al. Variations in cost calculations in spine surgery cost-effectiveness research. Neurosurg Focus. 2014;36:E1. doi:10.3171/2014.3.FOCUS1447.CrossRefGoogle ScholarPubMed
12.Mercier, G, Naro, G. Costing hospital surgery services: The method matters. PLoS One. 2014;9:e97290. doi:10.1371/journal.pone.0097290.CrossRefGoogle ScholarPubMed
13.Frick, KD. Microcosting quantity data collection methods. Med Care. 2009;47(Suppl):S76S81. doi:10.1097/MLR.0b013e31819bc064.CrossRefGoogle ScholarPubMed
14.Kaplan, RS, Porter, ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89:4652.Google ScholarPubMed
15.Neumann, PJ. Costing and perspective in published cost-effectiveness analysis. Med Care. 2009;47(Suppl):S28S32. doi:10.1097/MLR.0b013e31819bc09d.CrossRefGoogle ScholarPubMed
16.Tan, SS, Rutton, FF, Van Ineveld, BM, Redekop, WK, Roijen, LH-V. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2008;10:18. doi:10.1007/sl0198-008-0101-x.Google ScholarPubMed
17.National Hospital Cost Data Collection. Independent Hospital Pricing Authority; 2016. https://www.ihpa.gov.au/publications (accessed December 18, 2017).Google Scholar
18.Mishra, V, Fiane, AE, Winsnes, BA, et al. Cardiac replacement therapies: Outcomes and costs for heart transplantation versus circulatory assist. Scand Cardiovasc J. 2017;51:17. doi:10.1080/14017431.2016.1196826.CrossRefGoogle ScholarPubMed
19.Marasco, SF, Summerhayes, R, Quayle, M, McGiffin, D, Luthe, M. Cost comparison of heart transplant vs. left ventricular assist device therapy at one year. Clin Transplant. 2016;30:598605. doi:10.1111/ctr.12725.CrossRefGoogle ScholarPubMed
20.Patel, SR, Sileo, A, Bello, RB, et al. Heart transplantation versus continuous-flow left ventricular assist device: Comprehensive cost at 1 year. J Card Fail. 2015;21:160166. doi:10.1016/j.cardfail.2014.11.007.CrossRefGoogle ScholarPubMed
21.Duckett, S. Improving accountability for use of blood products. Report to the Australian Red Cross Blood Service. June 2013:124. https://www.ihpa.gov.au/sites/g/files/net636/f/Documents/australian_red_cross_blood_service_-consultation_paper_2016-17.pdf (accessed December 18, 2017).Google Scholar
22.Reeve, R, Haas, M. Estimating the Cost of Emergency Department Presentations in NSW. 2014:1–18. OPUS Library. http://hdl.handle.net/10453/33513 (accessed December 18, 2017).Google Scholar
23.Briggs, A, Grey, A. The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 1998;3:233245.CrossRefGoogle ScholarPubMed
24.Williams, ML, Trivedi, JR, McCants, KC, et al. Heart transplant vs left ventricular assist device in heart transplant-eligible patients. Ann Thorac Surg 2011;91:13301334. doi:10.1016/j.athoracsur.2011.01.062.CrossRefGoogle ScholarPubMed
25.Damato, A. Improving patient outcomes: Leveraging data to drive innovation in health care – New South Wales’ Activity-Based Funding management portal. BMC Health Services Research. 2015;15(Suppl 2):A1. doi.org/10.1186/1472-6963-15-S2-A1 (accessed November 9, 2018).CrossRefGoogle Scholar
26.Duckett, S. Blood money: Pathology cuts can reduce spending without compromising health. https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834 (accessed December 18, 2017).Google Scholar
27.Neil, A, Pfeffer, S, Burnett, L. Benchmarking in pathology: Development of a benchmarking complexity unit and associated key performance indicators. Pathology. 2013;45:6670. doi:10.1097/PAT.0b013e32835b77c4.CrossRefGoogle ScholarPubMed
28.Medicare Benefits Schedule Book Category 6. May 2014:1–113. http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/007A76CBC3437BF7CA257CCF00051C2E/$File/201403-Cat6.pdf (accessed December 18, 2017).Google Scholar

Prichard et al. supplementary material

Prichard et al. supplementary material 1

File 385 KB

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 12
Total number of PDF views: 78 *
View data table for this chart

* Views captured on Cambridge Core between 31st December 2018 - 5th March 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *