Costing Methodology and Key Drivers of Health Care Costs WithinEconomic Analyses in Musculoskeletal Community and Primary Care Services: ASystematic Review of the Literature

摘要

Identifying variation in musculoskeletal service costsrequires the use of specific standardized metrics. There has been a large focuson costing, efficiency, and standardized metrics within the acutemusculoskeletal setting, but far less attention in primary care and communitysettings. To ( ) assess the quality ofcosting methods used within musculoskeletal economic analyses based primarily inprimary and community settings and ( ) identify which costvariables are the key drivers of musculoskeletal health care costs within thesesettings. Medline, AMED, EMBASE, CINAHL, HMIC, BNI, andHBE electronic databases were searched for eligible studies. Two reviewersindependently extracted data and assessed quality of costing methods using anestablished checklist. Twenty-two studies met the reviewinclusion criteria. The majority of studies demonstrated moderate- tohigh-quality costing methods. Costing issues included studies failing to fullyjustify the economic perspective, and not distinguishing between short- andlong-run costs. Highest unit costs were hospital admissions, outpatient visits,and imaging. Highest mean utilization were the following: general practitioner(GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs perpatient were GP visits, outpatient visits, and physiotherapy visits. This review identified a number of key resource usevariables that are driving musculoskeletal health care costs in thecommunity/primary care setting. High utilization of these resources (rather thanhigh unit cost) appears to be the predominant factor increasing mean health carecosts. There is, however, need for greater detail with capturing these key costdrivers, to further improve the accuracy of costing information.