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. 2023 Oct;32(10):2987-2999.
doi: 10.1007/s11136-023-03442-w. Epub 2023 Jun 7.

Assessing micro- vs macro-costing approaches for treating appendicitis in children with appendicectomy or non-operatively

Maria Chorozoglou  1 , Isabel Reading  2 , Simon Eaton  3 , Shehryer Naqvi  4 , Caroline Pardy  4 , Keren Sloan  5 , Christina Major  5 , Natasha Demellweek  6 , Nigel J Hall  7   5
Affiliations

Assessing micro- vs macro-costing approaches for treating appendicitis in children with appendicectomy or non-operatively

Maria Chorozoglou et al. Qual Life Res. 2023 Oct.

Abstract

Objectives: We conducted a health economic sub-study within a feasibility RCT comparing a non-operative treatment pathway as an alternative to appendicectomy for the treatment of uncomplicated acute appendicitis in children. The objectives were to understand and assess data collection tools and methods and to determine indicative costs and benefits assessing the feasibility of conducting a full economic evaluation within the definitive trial.

Methods: We compared different methods of estimating treatment costs including micro-costing, hospital administrative data (PLICS) and health system (NHS) reference costs. We compared two different HRQoL instruments (CHU-9D and EQ-5D-5L) in terms of data completeness and sensitivity to change over time, including potential ceiling effects. We also explored how the timing of data collection and duration of the analysis could affect QALYs (Quality Adjusted Life Years) and the results of the cost-utility analysis (CUA) within the future RCT.

Results: Using a micro-costing approach, the total per treatment costs were in alignment with hospital administrative data (PLICS). Average health system reference cost data (macro-costing using NHS costs) could potentially underestimate these treatment costs, particularly for non-operative treatment. Costs incurred following hospital discharge in the primary care setting were minimal, and limited family borne costs were reported by parents/carers. While both HRQoL instruments performed relatively well, our results highlight the problem of ceiling effect and the importance of the timing of data collection and the duration of the analysis in any future assessment using QALYs and CUA.

Conclusions: We highlighted the importance of obtaining accurate individual-patient cost data when conducting economic evaluations. Our results suggest that timing of data collection and duration of the assessment are important considerations when evaluating cost-effectiveness and reporting cost per QALY.

Clinical trial registration: Current Controlled Trials ISRCTN15830435.

Keywords: Costing methodology; HRQoL and QALY; Hospital administrative data; Micro-costing; NHS Reference costs; Patient-Level Information and Costing Systems (PLICS).

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Conflict of interest statement

Authors declared no conflict of interest.

Figures

Fig. 1
Fig. 1
Resource use data
Fig. 2
Fig. 2
Treatment pathways for each treatment arm separated into domains
See this image and copyright information in PMC

References

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