Measures to Improve Cost Data Use for Health Economic Studies and Decision-Making – Overview of Existing Frameworks and Status Quo in Austria

Duration: April – November 2025 (5 PM)
Language: English (with German summary)

Background:
Cost data play a key role in health economic analyses, including health economic evaluations (HEE) and budget impact analyses (BIA). Costs in health economic analyses are usually calculated by multiplying the quantity of resources used in a patient's care or working unit (cost object), such as a hospital department, by a standard unit cost assigned to each resource type. The analysed costs typically include costs for hospital stays (per admission or per day), intensive care (daily rate), emergency department visits, clinic or primary care consultations (per visit), community nursing or therapy (hourly rate), diagnostic tests (per test), and medications (per tablet or vial) [1].

Beyond trial-based cost data collection (such as prospective measurement of resource use in randomised controlled trials), cost data can also be sourced elsewhere. Further data sources include observational or administrative data from routine clinical practice, so-called real-world cost data, as well as cost data from clinical or (hospital) managerial expert opinions (expert-estimated costs). Cost data may also be derived from other scientific sources (literature reviews, meta-analyses, etc.) or from standardised reference cost databases such as National Health Service (NHS) Cost Collections (Reference Costs) [2]or global estimates by WHO-CHOICE [3]and the Global Health Cost Consortium (GHCC) [4].

A few healthcare systems, such as the one in the United Kingdom (UK) [2]and the Netherlands (NL) [5], provide lists of rates, reference prices, or national cost collections for various types of resource use [1, 6, 7]. Furthermore, national health economic evaluation guideline (HEEG) or HTA guidelines define best practice approaches to costing that are appropriate for the specific jurisdiction. However, caution is needed when comparing unit costs internationally or within healthcare systems that use different approaches to calculate unit costs, as definitions of resource items may differ or the unit cost sources used in economic evaluations for comparable services in a specific jurisdiction remain heterogeneous [6].

Standard and validated unit cost reduces data variability – ensuring that any cost differences between interventions reflect actual resource use rather than differing valuations of the same resources^[1] [1]. Reducing heterogeneity within the data allows consistent comparison across different studies and sectors [8]. Therefore, standardised unit cost data reflecting the monetary value of resources is the basis for applying the fundamental criterion of economic considerations – the opportunity cost approach. Consequently, a set of standardised unit costs ensures evidence-based and informed decision-making regarding optimal allocation of resources in the healthcare system or, in simple terms, whether an intervention is worth its costs [9, 10].

In 2016, the Department of Health Economics (DHE) at the Medical University of Vienna developed a Microsoft Excel-based, publicly accessible catalogue of unit costs as reported in published Austrian economic evaluations and costing studies called the DHE Unit Cost Online Database [11, 12]. Furthermore, the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA), funded by the European Union (EU), provides a tool to calculate unit costs comparable across countries and sectors. It highlights some practical problems when calculating unit costs. Although the DHE Unit Cost Online Database and the PECUNIA were well-received by Austrian and international scientific communities, there are still some shortcomings regarding the availability and use of unit costs, partly due to the relatively minor role of efficiency considerations in health care decision-making in Austria [10]. Austria currently does not have a nationwide unit cost programme, a firmly established standardised method to calculate unit cost, or a universal unit cost database. In addition, current practices in Austria related to unit cost lack standardisation in data sources (LKF points/Austrian DRG system and hospital controlling data) and have regional variations (differences in unit costs across federal states).

Against this backdrop, the project aims to establish the foundations for a standardised calculation method and a permanently expandable unit cost database. The primary focus lies on applications in health economic analyses for Austrian decision-making processes, such as HTAs conducted in the Austrian Appraisal Board for selected, high-priced, and specialised medicinal products in the inpatient sector [13, 14]. Methodologically, it builds upon both literature identified within the project and insights from two key predecessor projects: the Austrian DHE Unit Cost Online Database [11, 12], which already provides a collection of national cost data, the EU-funded PECUNIA project [8]with its internationally comparative costing methods. These established approaches will be specifically adapted and further developed to meet the requirements of policy-relevant decision-making processes in Austria.

Objectives:
The project's main aims are to…

• Compare international best practices regarding unit cost calculation, use, and reporting (e.g., UK NHS Reference Costs, WHO-CHOICE, GHCC Unit Costing, remuneration system by the German Institute for the Hospital Remuneration System/InEK, PECUNIA) and outline basic concepts and methods in the unit cost context.
• Map existing cost data sources in Austria (e.g., LKF points/Austrian DRG system, hospital controlling data) and identify data fragmentation issues.
• Pilot selected unit cost calculation methods in selected reference hospitals and identify potential variability in unit costs across regions/hospitals.
• Propose best practice strategies for a sustainable national unit cost database and unit cost application in the Austrian context.

Non-objectives:
The report does not provide a universal unit cost framework nor a complete unit cost database for Austria.

Research questions:
The report addresses the following research questions (RQ):

1. What are the international best practices for calculating and reporting unit costs in health economic evaluations, and how can they be adapted for national standardisation?
2. How do existing national cost data sources (e.g., LKF points/Austrian DRG system and hospital controlling data) differ in scope, accuracy, and applicability for unit cost estimation?
3. To what extent do unit costs vary across settings when different calculation methods are applied, and what factors may contribute to these variations?
4. What structural and conceptual requirements are needed to enhance existing national unit cost data sources, including databases, and sustain unit cost use for health economic evaluations and decision-making?

Methods:

1. International best practices:  targeted literature review of (unit) costing methods in national HEEG and HTA guidelines, costing projects, programmes, and databases:
2. National HEEG and HTA guidelines sources such as ISPOR Overview of pharmacoeconomic guidelines [15], Guide to Economic Analysis and Research (GEAR) Online Resource [16], etc..
3. Costing projects, programmes, and databases such as the PECUNIA [8], NHS National Cost Collections (formerly Reference Costs) [2], the costing approach by the Personal Social Services Research Unit (PSSRU) [17, 18], GHCC Unit Costing [4], or the DHE Unit Cost Online [11]etc.
4. Consultation of experts of the respective identified country in case of insufficient or missing information.
5. Tabulation of identified countries, costing approaches, and further relevant characteristics.
6. Narrative synthesis and analysis of gathered information to identify common practices, differences, and implications for national standardisation in Austria).
7. Cost data sources: Mapping Austrian data sources and describing strengths and limitations.
8. Identifying existing and potential data sources, including existing databases for unit costs.
9. Outlining the data source's specific and general strengths/limitations.
10. Pilot: Applying selected calculation methods in selected hospitals and describe possible factors associated with variations in unit costs.
11. Structural and conceptual requirements: Defining a best-practice framework.

PICo analysis:

Abbreviations: HEE…Health economic evaluation, PICo…Problem, Interests, Context

Internal and external reviewers ensure the quality of the report.

References:

[1]        York Health Economics Consortium. Unit Costs [online]. 2016. Available from: https://yhec.co.uk/glossary/unit-costs/.

[2]        National Health Service (NHS). National Cost Collection for the NHS. 2024. Available from: https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/.

[3]        World Health Organisation (WHO). Quantities and unit prices (cost inputs). 2024. Available from: https://www.who.int/teams/health-financing-and-economics/economic-analysis/costing-and-technical-efficiency/quantities-and-unit-prices-(cost-inputs).

[4]        Global Health Cost Consortium (GHCC). Unit Cost Study Repository. 2025. Available from: https://ghcosting.org/pages/data/ucsr/app/.

[5]        Zorginstituut Nederland (National Health Care Institute Z. Costing manual: Methods and Reference Prices for Economic Evaluations in Healthcare 2024  [cited 23/04/2025]. Available from: https://english.zorginstituutnederland.nl/binaries/zinl-eng/documenten/reports/2024/01/16/guideline-for-economic-evaluations-in-healthcare/Module+-+Costing+manual.pdf.

[6]        Mayer S., Laszewska A. and Simon J. Unit Costs in Health Economic Evaluations: Quo Vadis, Austria? Int J Environ Res Public Health. 2022;20(1). Epub 20221222. DOI: 10.3390/ijerph20010117.

[7]        Mayer S., Fischer C., Zechmeister-Koss I., Ostermann H. and Simon J. Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations. Value Health. 2020;23(9):1142-1148. Epub 20200727. DOI: 10.1016/j.jval.2020.06.001.

[8]        Mayer S., Berger M., Peric N., Fischer C., Konnopka A., Brodszky V., et al. The Development of a New Approach for the Harmonized Multi-Sectoral and Multi-Country Cost Valuation of Services: The PECUNIA Reference Unit Cost (RUC) Templates. Appl Health Econ Health Policy. 2024;22(6):783-796. Epub 20240808. DOI: 10.1007/s40258-024-00905-0.

[9]        Drummond M. F., Sculpher M. J., Claxton K., Stoddart G. L. and Torrance G. W. Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2015.

[10]      Strohmaier C. and Zechmeister-Koss I. Threshold values in health economic evaluations and decision-making. Vienna: HTA Austria – Austrian Institute for Health Technology Assessment GmbH., 2023  [cited 21/01/2025]. Available from: https://eprints.aihta.at/1549/1/HTA-Projektbericht_Nr.163.pdf.

[11]      Department of Health Economics (DHE). DHE Unit Cost Online Database: Cost Collection from Existing Studies. Version 5.1/2024.: 2024. Available from: https://public-health.meduniwien.ac.at/en/our-departments/department-of-health-economics-dhe/research/downloads/dhe-unit-cost-online-database/access/.

[12]      Mayer S., Kiss N., Laszewska A. and Simon J. Costing evidence for health care decision-making in Austria: A systematic review. PLoS One. 2017;12(8):e0183116. Epub 20170814. DOI: 10.1371/journal.pone.0183116.

[13]      Bundesministerium für Arbeit, Soziales, Gesundheit, Pflege und Konsumentenschutz (BMASGPK),. Bewertungsboard: Sammlung von Frequently Asked Questions. 2025  [cited 25/04/2025]. Available from: https://www.sozialministerium.gv.at/dam/jcr:027211ef-cfb5-403f-9a5c-f8d0585d3c69/FAQs%20Bewertungsboard.pdf.

[14]      Bundesministerium für Arbeit, Soziales, Gesundheit, Pflege und Konsumentenschutz (BMASGPK),. Geschäftsordnung des Bewertungsboards. 2025  [cited 25/04/2025]. Available from: https://www.sozialministerium.gv.at/dam/jcr:f8781adf-e68c-4563-8a3b-38d99dff00c5/Gesch%C3%A4ftsordnung%20des%20Bewertungsboards%2028.06.2024.pdf.

[15]      International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Pharmacoeconomic Guidelines Around the World. 2025. Available from: https://www.ispor.org/heor-resources/more-heor-resources/pharmacoeconomic-guidelines.

[16]      Guide to Economic Analysis and Research (GEAR). Health economic evaluation guidelines. 2025. Available from: https://www.gear4health.com/gear/health-economic-evaluation-guidelines#query_box.

[17]      Personal Social Services Research Unit (PSSRU). Unit Costs of Health and Social Care programme (2022 – 2027). 2025. Available from: https://www.pssru.ac.uk/unitcostsreport/.

[18]      Jones K. C., Weatherly H., Birch S., Castelli A., Chalkley M., Dargan A., et al. Unit Costs of Health and Social Care 2023 Manual. Personal Social Services Research Unit (University of Kent) & Centre for Health Economics (University of York), Kent, UK: 2024. Available from: https://dx.doi.org/10.22024/unikent/01.02.105685.