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

Part of: Special Collection - Methods

Published online by Cambridge University Press:  31 December 2018

Roslyn Prichard Open the ORCID record for Roslyn Prichard [Opens in a new window] ,
Louise Kershaw ,
Patricia M. Davidson ,
Phillip J. Newton ,
Stephen Goodall  and
Christopher Hayward
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
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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.

Keywords

CostHeart failureVentricular assist
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 6 , 2018 , pp. 555 - 566
Copyright
Copyright © Cambridge University Press 2018 

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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

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