دورية أكاديمية
Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital.
| العنوان: | Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital. |
|---|---|
| المؤلفون: | Cardoso RB; National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil., Marcolino MAZ; National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil., Marcolino MS; Internal Medicine Division, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil., Fortis CF; National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil., Moreira LB; School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil., Coutinho AP; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil., Clausell NO; School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil., Nabi J; Harvard Business School, Boston, MA, USA., Kaplan RS; Harvard Business School, Boston, MA, USA., Etges APBDS; National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.; School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil., Polanczyk CA; National Institute of Science and Technology for Health Technology Assessment (IATS) (project: 465518/2014-1), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. carisi.anne@gmail.com.; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. carisi.anne@gmail.com.; School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. carisi.anne@gmail.com.; Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil. carisi.anne@gmail.com. |
| المصدر: | BMC health services research [BMC Health Serv Res] 2023 Feb 24; Vol. 23 (1), pp. 198. Date of Electronic Publication: 2023 Feb 24. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088677 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6963 (Electronic) Linking ISSN: 14726963 NLM ISO Abbreviation: BMC Health Serv Res Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2001- |
| مواضيع طبية MeSH: | Critical Pathways* , COVID-19*, Humans ; Brazil ; Prospective Studies ; Pandemics ; Time Factors ; Hospital Costs ; Hospitals ; Hospitalization ; Health Care Costs |
| مستخلص: | Background: The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. Methods: This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. Results: A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p < 0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. Conclusions: This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil. (© 2023. The Author(s).) |
| References: | Health Policy. 2017 Jul;121(7):755-763. (PMID: 28535996) J Eval Clin Pract. 2006 Feb;12(1):76-86. (PMID: 16422782) BMC Health Serv Res. 2021 Feb 11;21(1):132. (PMID: 33573650) J Healthc Eng. 2022 May 2;2022:3978577. (PMID: 35548482) Health Policy Plan. 2022 Oct 12;37(9):1098-1106. (PMID: 35866723) Harv Bus Rev. 2011 Sep;89(9):46-52, 54, 56-61 passim. (PMID: 21939127) Int J Infect Dis. 2021 Jun;107:300-310. (PMID: 33444752) J Med Syst. 2019 Dec 11;44(1):25. (PMID: 31828517) Int J Health Policy Manag. 2021 Apr 25;:. (PMID: 33949817) J Occup Environ Med. 2009 Jul;51(7):786-96. (PMID: 19528832) Acad Radiol. 2017 Feb;24(2):200-208. (PMID: 27988200) J Med Econ. 2021 Jan-Dec;24(1):308-317. (PMID: 33555956) Curr Opin Anaesthesiol. 2006 Apr;19(2):177-84. (PMID: 16552225) J Healthc Manag. 2014 Nov-Dec;59(6):399-412. (PMID: 25647962) J Health Econ Outcomes Res. 2021 Apr 16;8(1):36-41. (PMID: 33889651) Int J Surg. 2020 Jun;78:185-193. (PMID: 32305533) Eur J Health Econ. 2019 Nov;20(8):1133-1145. (PMID: 31286291) Braz J Infect Dis. 2021 Jul-Aug;25(4):101609. (PMID: 34454894) J Health Econ. 2014 May;35:34-46. (PMID: 24595066) BMJ Glob Health. 2016 Nov 11;1(3):e000134. (PMID: 28588971) Value Health. 2020 Jun;23(6):812-823. (PMID: 32540239) Int J Qual Health Care. 2011 Jun;23(3):331-41. (PMID: 21504959) BMC Health Serv Res. 2022 Aug 4;22(1):991. (PMID: 35922849) |
| فهرسة مساهمة: | Keywords: COVID-19; Cost and cost analysis; Health care costs; Microcosting; TDABC; Time-driven activity-based costing |
| تواريخ الأحداث: | Date Created: 20230224 Date Completed: 20230228 Latest Revision: 20230228 |
| رمز التحديث: | 20230228 |
| مُعرف محوري في PubMed: | PMC9955521 |
| DOI: | 10.1186/s12913-023-09049-8 |
| PMID: | 36829122 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder كن أول من يترك تعليقا!