Cost determination and calculation
The costs generated during the diagnostic evaluation process of both
units were analyzed based on a bottom-up
approach
(micro-costing) by which all
services provided are collected exhaustively and corresponding prices
are allocated. Micro-costing approaches stipulate all the resources
spent in the provision of healthcare service [16,17]. The
micro-costing analysis of this study was performed from the healthcare
provider perspective and, for all included patients, relevant costs were
obtained from the finance
departments of the two hospitals.
The primary outcome variable of the study was the mean cost per patient.
This cost was determined by
summing all the single cost components that contributed to patient
management until a diagnosis was made (i.e. from the first to the last
visit). Personnel costs were
calculated according to the staff time dedicated to each unit
(clinicians, nursing, and administrative staff). These costs
corresponded to the cumulative work time dedicated multiplied by the
average hourly income of the staff category. The costs of diagnostic
procedures including laboratory
and pathology investigations, imaging examinations and endoscopies, and
biopsy and cytology techniques were directly calculated using the unit
cost of each test as provided by the respective finance departments.
Direct costs attributable to
specialist consultation and
referral of patients were also incorporated. Indirect and structural
costs were finally imputed to the computation. We determined the
percentage distribution of direct, structural, and indirect costs
relative to the mean total cost per patient. Another variable of
interest for the study was the mean cost per visit. Neither costs borne
by patients nor costs of referring agencies were included in the
analysis. All costs were adjusted to the corresponding year (i.e. from
January 2009 to December 2016) and were measured in Euros (\euro).