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RESEARCH: Gerry Richardson, Karen Bloor, John Williams, Ian Russell, Dharmaraj Durai, Wai Yee Cheung, Amanda Farrin, and Simon Coulton Cost effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET) BMJ 2009; 338: b270 [Abstract] [Full text]

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Out of date costs in health economics analysis

D Graham Mackenzie   (2 March 2009)

Out of date costs in health economics analysis 2 March 2009
D Graham Mackenzie, Consultant in Public Health NHS Lothian, Deaconess House, 148 Pleasance, EH8 9RS Send response to journal: Re: Out of date costs in health economics analysis	Richardson and colleagues acknowledged a number of limitations in their study of the cost effectiveness of nurse versus doctor delivered endoscopy using data from a randomised controlled trial conducted between 2002 and 2003.1 The accompanying editorial notes the importance of cost per test to purchasers2 and Richardson and colleagues also identify the importance of affordability. In addition, however, it is important to point out that the use of 2002/3 prices in Richardson and colleagues’ paper will have had an important impact on the estimates of cost per test. Their analysis used costs of primary and secondary care based on the annual list of unit costs of health care produced by Lesley Curtis and colleagues at the Personal Social Services Research Unit (PSSRU). It would have been preferable to have used 2007/2008 prices. This is particularly relevant as there were major increases in pay for medical staff in the intervening period following the introduction of the GP and consultant contracts. Between 2002/3 and 2007/8 the listed cost per hour of patient contact for a GP increased from £127 to £183 and for medical consultant staff increased from £88 to £141.3 4 A search of BMJ.com for health economics papers published between 2007 and 2009 referencing Curtis identified a further 9 papers. These 9 papers were based on studies conducted over a period of up to a decade before publication of the economic analysis, but the prices were based on PSSRU reports published between 2004 and 2007. Although these studies all used substantially more up to date information on health costs than Richardson and colleagues, only one paper used data from the most recently published PSSRU report available at that time. Based on these observations, it appears that it is time for updated guidance on the conduct and reporting of health economics research for authors submitting papers to the BMJ, with specific advice on incorporating the most up to date information on the costs of health care. D Graham Mackenzie, Consultant in Public Health, NHS Lothian, Deaconess House, 148 Pleasance, EH8 9RS References 1) Richardson G, Bloor K, Williams J et al. Cost effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET). BMJ 2009;338;b270 2) Norton C, Grieve A, Vance M. Nurse delivered endoscopy. BMJ 2009; 338:a3049 3) Netten A and Curtis L. Unit Costs of Health and Social Care 2003. Personal Social Services Research Unit. University of Kent, 2003. http://www.pssru.ac.uk/pdf/uc2003/uc2003.pdf 4) Curtis L. Unit Costs of Health and Social Care 2008. Personal Social Services Research Unit. University of Kent, 2008. http://www.pssru.ac.uk/pdf/uc/uc2008/uc2008.pdf Competing interests: None declared