A comparison of different approaches for costing medication use in an economic evaluation
Value in Health
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Objective: Estimating individual-level medication costs within an economic evaluation can involve extensive data collection and handling. Implications of detailed versus general approaches are unclear. We compared costing approaches within a trial-based economic evaluation. Methods: We applied 4 costing approaches to prescribed medication data from the TACIT randomised controlled trial. A detailed micro costing approach was used as a base case, against which other approaches were compared: costing only medications used by at least 1.5% of patients; costing medications based only on chemical name; applying a generic prescription charge rather than 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 total health and social care costs. There was good agreement in prescribed medication costs (concordance correlation coefficient: (CCC) 0.815, 0.819, 0.989) and excellent agreement in total costs (CCC: 0.990, 0.995, 0.995) between approaches 1 and 2. Approaches 3 and 4 had poor agreement with approach 1 on prescribed medication costs (CCC: 0.246 to 0.700; and 0.033 to 0.333 respectively) but agreement on total care costs remained good (CCC: 0.778-0.993; 0.729-0.986). Conclusions: As medication costs comprised only a small proportion of total costs, the less resource intensive approaches had substantial impacts 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 where medication costs are likely to form a small proportion of total costs.
AuthorsPATEL, AK; Heslin, M; Babalola, O; Ibrahim, F; Stringer, D; Scott, D
- Population Health