Ward/outpatient clinic cost

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6.4 Ward/outpatient clinic cost

Except the actual treatment activities, all the other activity costs that occurred in the

‘place of treatment’ (including care, beddings change, meals, space and similar) were defined as the ward /clinic costs. For inpatients, the ward costs occurred in the ward.

For outpatients, the ward costs occurred in the outpatient clinic.

The ward cost was a key to the treatment cost calculation, as it encompassed two important parts missing from both the personnel costs and the overheads costs. Firstly, it contained all the care costs, including the human resources costs, which were excluded from the “personnel costs (for treatment purpose only)”. Secondly, it contained the cost of treatment space, which was not included in capital overheads in the ‘PSSRU Unit cost of Health and Social Care 2006-07 [179]’ (the source used in the current study to estimate the overheads costs).

For similar reasons to the ones described in the overheads costs section (difficult to itemize the ward cost, and to re-allocate all the activities separately), the national price list was used as the unit cost for ward/outpatient clinic. The relevant details are described in the following paragraphs.

6.4.1 Assumptions

For the required calculation, a number of assumptions had to be made:

a. It was assumed that no “single / multi people” or “standard / specialist” wards differences existed, as this information was not available in the study databases.

b. It was assumed that each inpatient used the same amount of care resources in ward for every inpatient day, and also the same with each outpatient in the outpatient treatment place for every outpatient visit.

c. It was assumed that under different inpatient-based treatments, all the inpatients used the same amount of care resources both with one another, and also with all the outpatients.

d. It was assumed that all the outpatient visits occurred in the hospital.

6.4 Ward/ outpatient clinic cost

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6.4.2 Unit cost

A number of different publications were used in order to obtain robust and reliable estimations of the ward unit cost for the inpatient stay and of the clinic unit cost for outpatient visit.

a. Inpatient

According to the ‘Nursing care for older people’ from the Personal Social Services Expenditure and Unit Costs England, 2006-07 [187], the cost of hospital stay was found to be £467 per week (£67 per day in round numbers). The reason for using this information as ward cost was that the cost of nursing care for older people could reflect the cost of simple care duty in the ward (which matches the study design of the current study). Regarding the other information sources, such as the reference cost or the national tariff, it was decided that they could not provide the precise cost of simple care duty in ward, as all the costs provided contained the care duty and the relevant treatment costs.

b. Outpatient

According to the “outpatient specialty code 324: Anticoagulant Service Total Attendances” from the ‘Reference Cost Index’, the cost of an outpatient visit was found to be £19 per visit (based on Consultant Led Follow up Attendance Outpatient Face to Face for Adult Attendance). The reason for choosing this information as the outpatient clinic cost was that the anticoagulant service was the closest estimate to all the non-treatment costs that occurred in outpatient clinics. This was because the anticoagulant service involved the least treatments and examinations (compared to other outpatient visits mentioned in the ‘Reference Cost Index’).

c. Sampling

According to the ‘Pathology Services’ from the ‘Reference Cost’, the cost of the blood sampling was £3 per sampling (Haematology - code: DAP823), while the cost of the tissue sampling (such as bone marrow sampling) was £26 per sampling (Histology / Histopathology– code: DAP824).

6.4.3 Quantity

The quantity for the ward/outpatient clinic cost calculation was based on ‘the number of use’.

6.4 Ward/ outpatient clinic cost

- 158 - Table 6.8 The summary of ward costing method

Ward/space cost of each treatment/intervention

Unit cost Quantity

Inpatient treatments

Nursing care for older

people (£67) Hospital stays Chemotherapy

Laboratory test Reference Cost Index Numbers of sampling

a. Inpatient

For the inpatient treatments, the quantity for the ward cost calculation was defined as the

‘hospital stays’. Because of information insufficiency reasons (as mentioned in Chapter 5), the’ number of hospital stays’ for each cycle of treatment was derived from the relevant imputations (imputed by the assistance of ‘treatment time’ derived from the HMRN database, additional information from medical notes, and clinical guidelines/protocol).

b. Outpatient

For the outpatient treatments, the quantity for outpatient clinic cost calculation was defined as the ‘number of outpatient visits’. Since the exact visit dates were not obtainable from the HMRN database, the outpatient visit frequency was set to once per month during the ‘treatment time’ (according to expert opinions). Therefore, the number of outpatient visits was possible to be obtained by simple division.

c. Sampling

For the sampling, the quantity for the sampling place cost calculation was defined as the

‘number of sampling’. This information could be easily obtained by simple addition, as the exact sampling/screen dates could be derived from the HILIS database (the subset database of HMRN database).

Overall, the ward/space cost could be calculated by the multiplication of the unit cost (from three different information sources) and the quantity (number of uses). The summary of the ward costing method for each treatment is shown on Table 6.8.