An accurate estimation of individual costs is essential in economic evaluation, payment systems analysis and in general, in a number of works which can be included into the health economics spectrum. Obtaining such individual or patient costs remains a complex challenge and faces numerous obstacles. The Bottom up microcosting methodology refers to the most detailed patient-specific resource consumption measurement and is considered the gold standard in the economic evaluation literature. However, its implementation is expensive and time consuming [1]. According to Wordsworth et al. [2] Bottom up microcosting is the desirable method for labour costs and other cost components that have a great impact on total costs. Tan et al. [3] showed how the selection of a different methodology (Top down microcosting or Bottom up gross costing) for labour costs and other critical cost components can produce differences in patient cost estimates in comparison with the gold standard. Clement et al. [4] investigated to what extent the selection of the costing methodology can affect the results of an economic evaluation and produce further wrong decisions. Other problems accepted by the health economics literature in the analysis of individual healthcare costs are the existence of missing data [5,6] or the application of inadequate costing methods [7].
The costing methodology we use combines the Bottom-Up and the Top-Down approaches described in Mogyorosy and Smith [1]. Thus, we add up direct costs of patients stemming from their related clinical records and calculate other costs from the different company departments. During year 2005, total expenses presented by the SSIBE balance sheet accounted for 45,868,690.45 € (excluding financial expenses, provisions, stock differences and taxes). In the next paragraphs we describe how the methodology deals with the different types of costs.
The first category of costs, direct costs (10.98% of the total expenditures), is obtained by a Bottom Up approach as the sum of balance sheet expenses directly related to patients. They include direct costs from blood transfusions, prostheses, intermediate products, and pharmaceutical consumption.
The second category of costs, departmental costs, suppose the most important proportion of costs within the institution (71.85%), and include costs of health services which can be charged to patients using average costs and individual patient data on use of services resources (Top- Down microcosting approach). Examples of the costs recorded in this category are the number of hospital stays, laboratory tests or rehabilitation sessions.
Lastly, the third category of costs, indirect costs (supposing 17.17% of total costs) include company fixed costs as management, accounting, building amortisation, and other costs not related to the activity. Differently to direct and departmental costs, indirect costs cannot be assigned directly to patients based on use. Therefore, we need to assign to each patient a fair proportion of the general overheads.
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