A Comparison of Different Approaches for Costing Medication Use in an Economic Evaluation

Margaret Heslin*, Oluwagbemisola Babalola, Fowzia Ibrahim, Dominic Stringer, David Scott, Anita Patel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
167 Downloads (Pure)

Abstract

Background
Estimating individual-level medication costs in an economic evaluation can involve extensive data collection and handling. Implications of detailed versus general approaches are unclear.

Objectives
To compare costing approaches in a trial-based economic evaluation.

Methods
We applied four costing approaches to prescribed medication data from the Tumour necrosis factor inhibitors Against Combination Intensive Therapy randomized controlled trial. A detailed micro-costing approach was used as a base case, against which other approaches were compared: costing medications used by at least 1.5% of patients; costing medications on the basis of only chemical name; applying a generic prescription charge rather than a medication-specific cost. We quantitatively examined resulting estimates of prescribed medication and total care costs, and qualitatively examined trial conclusions.

Results
Medication costs made up 6% of the total health and social care costs. There was good agreement in prescribed medication costs (concordance correlation coefficient [CCC] 0.815, 0.819, and 0.989) and excellent agreement in total costs (CCC 0.990, 0.995, and 0.995) between approaches 1 and 2. Approaches 3 and 4 had poor agreement with approach 1 on prescribed medication costs (CCC 0.246–0.700 and 0.033–0.333, respectively), but agreement on total care costs remained good (CCC 0.778–0.993 and 0.729–0.986, respectively).

Conclusions
Because medication costs comprised only a small proportion of total costs, the less resource-intensive approaches had substantial impacts on medication cost estimates, but had little impact on total care costs and did not significantly impact the trial’s cost-effectiveness conclusions. There is room for research efficiencies without detriment to an evaluation in which medication costs are likely to form a small proportion of total costs.

Keywords
Original languageEnglish
Pages (from-to)185-192
Number of pages8
JournalValue in Health
Volume21
Issue number2
Early online date21 Feb 2018
DOIs
Publication statusPublished - Feb 2018

Keywords

  • costs
  • economic
  • medication
  • trial

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