Terri Jackson

Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies

Casemix-funding systems for hospital inpatient care require a set of resource weights which will not inadvertently distort patterns of patient care. Few health systems have very good sources of cost information, and specific studies to derive empirical cost relativities are themselves costly. This paper reports a 5 year program of research into the use of data from hospital management information systems (clinical costing systems) to estimate resource relativities for inpatient hospital care used in Victorias DRG-based payment system. The paper briefly describes international approaches to cost weight estimation. It describes the architecture of clinical costing systems, and contrasts process and job costing approaches to cost estimation. Techniques of data validation and reliability testing developed in the conduct of four of the first five of the Victorian Cost Weight Studies (1993-1998) are described. Improvement in sampling, data validity and reliability are documented over the course of the research program, the advantages of patient-level data are highlighted. The usefulness of these byproduct data for estimation of relative resource weights and other policy applications may be an important factor in hospital and health system decisions to invest in clinical costing technology.

Cost effectiveness of rotavirus vaccination in Australia.

OBJECTIVE Rotavirus gastroenteritis causes substantial morbidity, including hospital admission, in young children. In the context of recent vaccine developments, this study aimed to estimate the cost-effectiveness of a rotavirus vaccination program in Australia. METHOD Standard methods of health economic evaluation were used to assess the total cost of rotavirus immunisation (as the difference between estimated vaccination program costs and the cost of disease that would be avoided by immunisation) and relate this to the number of cases of disease that would be prevented. Estimates were made from both societal and health care systems perspectives. RESULTS Based on Australian data on disease incidence and cost of hospitalisation, the current annual cost of rotavirus disease is about

Diagnosis of appendicitis in adults by ultrasonography or computed tomography: A systematic review and meta-analysis

26.0 million. Using conservative vaccine efficacy estimates, current immunization uptake rates and a cost of

Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research

30 per dose of vaccine, rotavirus immunisation would incur a net societal cost of

Cost estimates for hospital inpatient care in Australia: evaluation of alternative sources.

2.9 million (

The costs and adverse events associated with hospitalization of patients with spinal cord injury in Victoria, Australia.

11 per child), at a gross program cost of

Incremental costs of hospital-acquired complications in Alberta, Canada

21.6 million. These estimates are sensitive to two sources of uncertainty in the estimation of program delivery costs: vaccine price and whether separate immunization visits would be required. CONCLUSION A rotavirus immunisation program would be cost-neutral to Australian society at a vaccine price of

Part I: Propofol, Thiopental, Sevoflurane, and Isoflurane—A Randomized, Controlled Trial of Effectiveness

26 per dose (or

Adverse event rates as measures of hospital performance

19 when health care system costs only are considered). IMPLICATIONS Rotavirus immunization may be cost-effective in Australia, but considerable uncertainty remains. Policy decisions will depend heavily on pricing of the vaccine and may also need to consider intangible costs not accounted for in this analysis.

Prospective payment to encourage system wide quality improvement

OBJECTIVES The use of ultrasonography and computed tomography (CT) in the diagnosis of appendicitis in adult patients was compared. METHODS Systematic review and meta-analysis of current evidence in two clinical situations: unselected nonpregnant, adult patients with symptoms of appendicitis, and more selective use in only those patients who still have an equivocal diagnosis subsequent to routine clinical investigations. RESULTS Meta-analysis of eligible studies shows CT to have better sensitivity and specificity than ultrasound in both clinical situations. CONCLUSIONS Application of these findings in clinical practice and/or policy would need to evaluate the better diagnostic performance of CT against its cost and availability. In addition, it is imperative that future studies be conducted in patient populations that are well-defined with respect to prior investigations. Sequelae of false-negative and false-positive diagnoses should also be evaluated.