Economic Costs and Outcomes that Matter to Patients
Assigning and capturing costs related to seeking or delivering care.
One of the key questions researchers ask when conducting an economic evaluation is: How much does this intervention cost to an individual, organization, or society at large? The process requires researchers to identify the perspectives of affected stakeholders and analyze the costs related to the intervention. To better understand the burdens and economic impact of healthcare costs from the patient perspective, the Patient-Centered Outcomes Research Institute (PCORI) developed two resources to 1) provide researchers guidance for assigning costs and 2) capture out-of-pocket costs that matter to patients and caregivers.
The guidelines were compiled by researchers at the Patient-Centered Outcomes Research Economic Resource Center (PCOR-ERC) who conducted a systematic literature review and scoping review of U.S. studies that included recommended approaches and commonly used practices for conducting a cost analysis.
The resources support current and prospective PCORI investigators but are also relevant to other health economic and health services researchers who are collecting data on economic costs and outcomes that patients, providers, and policy makers value.
Assigning Costs to Healthcare Utilization
Key Considerations
- Time-driven activity-based costing (TDABC), micro-costing, and activity based costing (ABC) systems are methods best suited for capturing costs and variations at a local-level, service-level, or patient-level. These three methods, require more resources to implement but offer greater accuracy for identifying the drivers of costs and quantities of resources used during a health care treatment. TDABC and micro-costing estimates are not generalizable to other settings.
- Administrative data and gross costing are methods best suited for making generalizable estimates, particularly when data across multiple sites is readily available and representative of a group of patients. These methods can leverage data that are already being collected as part of the research study, and thus, can easily determine the average cost.
Assigning Costs to Healthcare Utilization
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Out-of-Pocket and Indirect Patient and Caregiver Cost Taxonomy
Key Considerations
- Direct medical costs, direct nonmedical costs, or indirect costs are the main categories used to group out-of-pocket (OOP) costs paid by patients or caregivers. The study identified a total of 36 different OOP cost elements that can inform decision makers of healthcare costs.
- Direct medical costs include medical care. Examples are copays, over-the-counter medication, and at-home care.
- Direct nonmedical costs include care used to treat or manage a disease. Examples are childcare, transportation, patient education*, and eating away from home*.
- Indirect costs include other non-monetary costs that impact patients or caregivers. Examples are time spent on doctor visits, loss of volunteer work*, and mortality*.
*Cost elements that have not been identified by the three systematic reviews or reports used in the study.
