Identifying unit costs for use in regional economic evaluation: an illustrative analysis of childhood pneumococcal conjugate vaccine in Latin America and the Caribbean.

E, de la Hoz F, Valenzuela MT, et al. Identifying unit costs for use in regional economic evaluation: an illustrative analysis of childhood pneumococcal conjugate vaccine in Latin America and the In conducting economic evaluations of new medical interventions , data from empirical studies offer a ready source of information regarding the use of health care resources by patients undergoing different treatments. Without major additions to the data collection burden, it is possible to record the frequency of consultations and hospitalizations, the length of hospital stays, and the number and type of diagnostic and therapeutic procedures used. However, converting the resource use data, which are measured in physical units, into cost data, for the purpose of cost-effectiveness analysis, requires the application of unit costs. This poses problems when empirical studies are carried out on a multicenter basis, as unit costs vary across centers (i.e., unit costs observed in one center may not be representative of the country or health care system in which the study is being conducted), and direct measurement of unit costs in multiple centers to improve representativeness is usually expensive in terms of time and resources. While some countries have nationally recognized charges or reimbursement rates for particular procedures, these types of costs may not be at a sufficient level of disaggregation for use in the context of a research exercise, as they usually apply to episodes of care rather than individual consultations or treatments. This problem is exacerbated when the empirical study is conducted on a multi-country basis (e.g., in an international study in which resource data have been collected across several countries). If the study has been designed to test hypotheses on the pooled data, the selection of unit costs (for converting resource use into costs) becomes even more problematic. In conceptual and practical terms, the currently accepted method in economic evaluations is to measure resource use in the empirical study and apply unit costs derived from high-quality external sources (1). In international empirical studies, the most common practice is to apply the unit costs from one country to the pooled resource data for patients participating in the study, to facilitate cost-effectiveness comparisons. However, sources for this type of unit cost data are scarce, as are methods by which to develop such data for multinational studies. Therefore, the main objective of this report is to provide a detailed example of how such costing might be …