Valuation of resources

Resources / Valuation method
Hospital and rehabilitation care (inpatient and outpatient) / Cost per diem based on the regional tariffs reported by the diagnosis-related groups (DRG) [1,2, 3]
Nursing homes / Costs derived from estimates provided by staff working at health facilities
Diagnostic and laboratory test and specialist visits / Costs evaluated according to tariffs set in the national fee-schedules [3]; for general practitioners (GP) the unit cost estimated from a published empirical study [4]
*Disease modifying drugs (DMDs) and other prescribed medications / Public prices (DMDs ex-factory price) obtained from the Italian Pharmaceutical Agency (AIFA) [5] or for over-the-counter medication based directly on patients’ responses
Transportation / Costs estimated on the basis of the distance between the place of care and patients’ home using an average cost per kilometer
Professional help (paid assistance) included nurse intervention in-home, home-help and healthcare assistance. / Cost per hour of professional help based on “National Tariff for nurse activities and interventions” [6], and on minimum tariff for the two type of assistance reported in the “National collective agreement for home labor services” [7] for domestic help and healthcare assistance
Investments (stair, bed lift, ramps, rails) or standard devices (walking aids, wheelchairs, etc) / Cost obtained from public source [8] or based directly on patients’ responses when it was purchased directly from the patient
Trans-formation to car, house / Cost based directly on patients’ responses
Informal care / Costs evaluated according to the nature of time spent for providing assistance (leisure or working time) [9].The National Agreement for Home Labour Services was used to evaluate the time invested by caregivers (for surveillance and direct care, range between 6-7 €/h) [10]. Working days lost by caregivers, as well as their loss or reduction of working activity, were evaluated according to the Human Capital Approach [11] on the basis of the data derived from Bancad’Italia statistics [12].
Production losses / Human Capital Approach. Patients’ paid time off work was evaluated on the basis of the average annual costs of labor in different sectors of activity, according to the Bancad’Italia statistics 2011 [11]. The cost of short-term sick leave was estimated using average labour costs (including employers' contributions of 39%) adjusted by actual working hours of patients concerned. Production losses due to long-term sick leave and early retirement were valued using gender-specific labour costs for full-time work.
Intangible costs / The cost was estimated by assigning a monetary value (equal to €50,000) to each QALY lost, which is gained from benchmark values in economic evaluations [13]

*MS drugs (DMDs) were assumed to be self-injected, however, the cost of the visit was not added to the cost of the medication to avoid double-counting of resources, since patients reported separately any outpatient visit to hospitals/treatment centers they had during the past 3 months.

References

  1. Diagnosis Related Groups. National Tariffs for Italy. 2006. (Accessed April 2011)
  2. Tariffa Unica Convenzionale per le prestazioni di riabilitazione ospedaliera 2009. (Accessed April 2011)
  3. Ministry of health. Tariffs for ambulatory services in Italy. 1996. (Accessed March 2010)
  4. Lucioni C, Garancini MP, Massi-Benedetti M, Mazzi S, Serra G (2000) Il costo sociale del diabete di tipo 2 in Italia: lo studio CODE-2. PharmacoEconomics Italian Research Articles, 2: 1–21
  5. ItalianPharmaceuticalAgency (Agenzia Italiana del Farmaco). Drug prices. 2007. (Accessed March 2010)
  6. National Tariff for nurse activities and interventions (Accessed April 2011)
  7. National collective agreement for home labor services (Accessed April 2011)
  8. National Tariff for special equipment and technical aids (Accessed April 2011)
  9. Posnett J, Jan S (1996) Indirect cost in economic evaluation: the opportunity cost of unpaid inputs. Health Economics 5: 13–23
  10. Gerzeli S, Tarricone R, Zolo P, Colangelo I, Busca MR, Gandolfo C (2006) The economic burden of stroke in Italy. The EcLIPSE study: economic longitudinal incidence-based project for stroke evaluation. NeurolSci 26: 72–80
  11. Koopmanschap MA, Rutten FF (1993) Indirect costs in economic studies. Pharmacoeconomics 4: 446–454
  12. Banca d’Italia (2012) I bilanci delle famiglia Italiane nell’anno 2010. Supplementi al BollettinoStatisticoIndaginiCampionarie Anno XXII n.6
  13. Eichler GH, Kong SX, Gerth WC, Mavros P, Jönsson B (2004) Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge? Value Health 7(5): 518-28