281381
Improving cost-effectiveness analysis in maternal and child health: A practical approach for calculating reliable cost estimates from observational data
Jason L. Salemi, MPH,
Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Meg Comins, MPA,
Health Policy and Management, University of South Florida College of Public Health, Tampa, FL
Mulubrhan Mogos, PhD,
Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Hamisu Salihu, MD, PhD,
Department of Epidemiology and Biostatistics, University of South Florida, College of Public Health, Tampa, FL
Background: Comparative effectiveness research (CER) and cost effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. Methods: In Florida, we have constructed a clinically-enhanced, longitudinal, encounter-level maternal and child health (MCH) database covering over 2.3 million infants (and their mothers) born alive from 1998-2009. We describe a detailed methodology to use publicly-available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to our database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis on women with and without gestational diabetes (GDM) to compare the impact of using different methods for cost estimation. Results: Over 60% of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which has a very different charge-to-cost markup (CCR=0.70) than the commonly-substituted hospital average (CCR=0.29). Using estimated per-patient maternal hospitalization costs for women with GDM as an example, unadjusted charges ($14,696) grossly overestimated actual cost, compared to hospital-wide ($3,498) and cluster-specific ($4,986) CCR adjustment. However, the cost estimation method did not have a strong impact on our conclusions that infant/maternal hospitalization costs were significantly higher for women with GDM than without. Conclusions: Cost estimates, particularly among MCH-related services, vary considerably depending on the adjustment method. Our approach will be valuable to researchers interested in incorporating more valid estimates of cost into databases with linked hospital discharge data.
Learning Areas:
Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology
Public health administration or related administration
Public health or related public policy
Public health or related research
Learning Objectives:
Describe several approaches used to estimate facility-based costs from charges reported in hospital discharge data.
Identify publicly-available datasets that can be used to calculate hospital-wide and department-specific cost-to-charge ratios.
Discuss the impact that the choice of cost estimation method can have on cost effectiveness analyses in maternal and child health.
Keyword(s): Cost Issues, Maternal and Child Health
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I am currently an Epidemiology and Statistical Data Analysis Manager who has served on several state and federal MCH grants, using linked data. I have created novel e-Learning and m-Learning modules, as well as interactive face-to-face lectures and vicarious learning exercises, to build the capacity of multidisciplinary team of researchers to conduct cost-effectiveness analysis and consider cost-related issues.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
