Development of the European Healthcare and Social Cost Database (EU HCSCD) for use in economic evaluation of healthcare programs

Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 h ps://doi.o g/10.1186/s12913-022-07791-z DATABASE De elopmen o  heEu opean Heal hca e andSocial Cos Da abase (EU HCSCD) o use ineconomic e alua ion o heal hca e p og ams Jaime Espín1,2,3 , Zuzana Špací o á1,2,3* , Joan Ro i a1 , Da id Eps ein4 , An onio Ol y de Lab y Lima1,2,3 and Le icia Ga cía‑Mochón1,2,3 Abs ac In oduc ion: Cos s a e one o he c i ical ac o s o he ans e abili y o he esul s in heal h echnology assessmen and economic e alua ion. The objec i e is o de elop a cos da abase a he Eu opean le el o acili a e c oss‑bo de cos compa isons in di e en se ings and explains he ac o s ha lead o di e ences in heal hca e cos s in di e en coun ies, aking in o accoun he di e ences be ween heal h sys ems and o he ac o s. Me hodology: The co e o he da abase is compounded o h ee main ca ego ies (p ima y esou ces, composi e goods and se ices, and complex p ocesses and in e en ions) o ganized in o 13 subca ego ies. A numbe o ele‑ men s p o iding as de ailed in o ma ion o uni cos as possible we e iden i ied in o de o mi iga e he p oblem o compa abili y. Conso ium pa ne s alida ed bo h he da abase s uc u e and selec ed cos ing i ems. Resul s: Twen y‑se en cos ing i ems included in he EU HCSCD esul ed in 1450 uni cos s when aking in o accoun all i em sub ypes and coun ies. C oss‑coun y di e ences in cos s a e d i en by he ype o esou ces included in he cos ing i ems (e.g., o e head cos s in case o complex p ocesses and in e en ions) o by he a ie y o exis ing b ands and/o models and he ype o uni alue in mos o he p ima y esou ces. Conclusion: The EU HCSCD is he only public uni heal hca e and social cos da abase a Eu opean le el ha ga he da a on uni cos s and explains di e ences in cos s ac oss coun ies. I s main enance and egula da a upda ing will enable es ablishing speci ic sys ems o gene a ing and eco ding in o ma ion ha will mee many o i s cu en limi a ions. Keywo ds: Cos s, Economic e alua ion, T ans e abili y, Da abase, Cos ing me hodology © The Au ho (s) 2022. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which pe mi s use, sha ing, adap a ion, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i changes we e made. The images o o he hi d pa y ma e ial in his a icle a e included in he a icle’s C ea i e Commons licence, unless indica ed o he wise in a c edi line o he ma e ial. I ma e ial is no included in he a icle’s C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his licence, isi h p:// c ea i eco mmons. o g/ licen ses/ by/4. 0/. The C ea i e Commons Public Domain Dedica ion wai e (h p:// c ea i eco mmons. o g/ publi cdoma in/ ze o/1. 0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed in a c edi line o he da a. Backg ound Economic e alua ions (EE) a e ecognised as a key ele- men o p io i y se ing decisions in Heal h Technology Assessmen . EE should be an unbiased and anspa en exe cise, and should add ess issues o gene alizabili y ( he deg ee o which he esul s o an obse a ion hold ue in o he se ings) [1] and ans e abili y (designing and epo ing e alua ions in such a way ha a leas some componen s can be eusable in o he se ings) [2]. T ans- e abili y can be g ea ly enhanced by ollowing good p ac ice by es ima ing and epo ing uni s o esou ces sepa a ely om he uni mone a y alues −p ice o uni cos − o hose esou ces. Hence accu a e uni cos s a e essen ial inpu s o eco- nomic e alua ions. Uni cos da a a e a ailable om mul i udinous sou ces, o example: p e ious li e a u e, na ional da abases, heal hca e p o ide adminis a i e Open Access *Co espondence: zuzana.spaci o[email p o ec ed] 1 Andalusian School o Public Heal h/Escuela Andaluza de Salud Pública (EASP), Cues a del Obse a o io 4, 18011 G anada, Spain Full lis o au ho in o ma ion is a ailable a he end o he a icle Page 2 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 o billing sys ems, o expe opinion. This di e si y o sou ces can make in e p e a ion and gene alizabili y o economic e alua ions challenging. The uni cos s o simila -seeming esou ce i ems may a y, o example, due o di e ences in he de ini ion o he uni o ac i - i y, he quan i y, quali y o mix o esou ce inpu s used in p o iding a se ice o ac i i y, a e age p ice le els ac oss coun ies and ac oss ime, luc ua ions in cu ency exchange a es, o cos -accoun ing me hodology [3]. HTA e alua ions need o be adjus ed o ci cums ances in each na ional (o e en egional) con ex , and sponso s o heal h echnologies o o he esea che s o en a emp o cons uc ans e able e alua ions ha can be adjus ed ac oss coun ies and ju isdic ions, a he han s a ing a new analysis om sc a ch [4]. To add ess hese issues, he Eu opean Heal hca e and Social Cos Da abase (EU HCSCD) [5] o use in Heal h Technology Assessmen (HTA) ac oss coun ies has been de eloped. The emi o EU HCSCD is o p o ide a eely-a ailable da ase o uni cos s o commonly used heal hca e esou ce i ems ac oss Eu opean coun ies, and builds on p e ious Eu opean-wide p ojec s Heal hBAS- KET [6] and Eu oDRG [7]. Exis ing c oss-coun y uni cos da abases equi e a ee [8], o a e designed o s a e- gic heal h planning in low and middle-income coun ies ( he OneHeal h Tool [9]). Hence he EU HCSCD mee s an unme need among esea che s, and i is expec ed o p o ide se e al ben- e i s. Fi s , he EU HCSCD will imp o e ans e abili y by making i easie o ca y ou mul i-coun y s udies and o adap economic e alua ion s udies om coun y o coun- y, hence sa ing human esou ces ime and expense in he ask o inding app op ia e heal hca e and social uni cos s. Second, he da abase has in o ma ion no only on he uni cos , bu also desc ibes how ha i em was con- s uc ed o es ima ed in a common o ma . This in o ma- ion may help esea che s explo e and explain a ia ion in uni cos s be ween and wi hin coun ies. Will imp o e anspa ency by p esen ing uni cos s es ima ed in di e - en coun ies in a common o ma , allowing any a ia- ion in uni cos s o be explo ed and explained. Thi d, he a ailabili y o his de ailed c oss-coun y esou ce may help na ional da a p oduce s (such as hose esponsible o Diagnos ic Resou ce G oups) iden i y s eng hs and weaknesses in hei cos ing me hodology and, o e ime, may p omo e he s anda diza ion and imp o emen o hese sou ces . The EU HCSCD includes bo h heal hca e and social (non-heal hca e and p oduc i i y) cos s. This pape desc ibes he cons uc ion and con en o he heal h- ca e uni cos s module, which was de eloped in he wo k package ‘De eloping a cos ing me hodology and a co e da ase o cos s o acili a ing c oss bo de compa isons in economic e alua ions’ o he IMPACT-HTA p ojec (No 779312) [10]. Cons uc ion andcon en S uc u e o  heEU HCSCD The uni cos s in he da abase a e classi ied in o h ee main ca ego ies: p ima y esou ces ( hose ha canno be u he di ided in o smalle uni s, such as cos pe hou o p o essionals o p ices o medicines), composi e goods and se ices (bundles o se e al p ima y esou ces ha a e consumed join ly, such as a day in a hospi al wa d, o an ou pa ien isi ), and complex p ocesses and in e - en ions (uni s o ac i i y ha agg ega e di e se ypes o esou ces, such as medical in e en ions and su gical p ocedu es). Table1 p o ides an o e iew o he ca ego- ies, subca ego ies o he 27 i ems cu en ly lis ed in he EU HCSCD. Each i em may ha e se e al ields co e- sponding o he sou ces a ailable in each coun y. Fields desc ibing heEU HCSCD cos ing i ems Ensu ing compa abili y consis s o collec ing as de ailed in o ma ion on cos ing me hodologies used o es ima e cos o each i em included in he EU HCSCD as possi- ble. This means he knowledge abou wha esou ces a e included in he cos , how we e he esou ces es ima ed and how was he uni cos calcula ed and assigned o he esou ces. In he long e m, he compa abili y can only be a ained i all coun ies/ins i u ions use he same accoun ing me hodology. Howe e , he uni al- ues applied a p esen ha e di e en o igins, no only cos accoun ing om heal h ca e o ganiza ion, bu also ma ke p ices, a i s, public p ices, e c. The e o e, all he ields desc ibed below ha e been included in he cos da abase o mi iga e he p oblems o compa abili y (Table2). Da a collec ion Sea ches we e ca ied ou on he heal h o ganiza ions’ websi es (e.g., EUne HTA, NHS England, Eu opean Obse a o y on Heal h Sys ems and Policies, Depa - men o Heal h (London), Cen e o Heal h Economics (Uni e si y o Yo k), e c.) and he mos p e alen diseases wo ldwide we e checked in o de o decide which cos - ing i ems (in e en ions, medicines, medical de ices, e c.) a e among he mos used in economic e alua ions and, he e o e, should be included in he be a e sion o he da abase. A leas one cos ing i em was selec ed wi hin each cos ing subca ego y. Thus, 27 cos ing i ems we e included in he EU HCSCD, which esul ed in 1450 cos s when 9 coun ies (England, F ance, Ge many, I aly, Poland, Po ugal, Slo enia, Spain and Sweden) and all i em sub ypes we e aken in o accoun [5]. The nex s ep consis ed o iden i ying o icial cos da abases con aining Page 3 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 Table 1 S uc u e o he Eu opean Heal hca e and Social Cos Da abase: Ca ego ies, subca ego ies and i ems Ca ego y Subca ego y De ini ion Cos ing i ems P ima y (homogenous) esou ces Medicines D ug o o he p epa a ion o he ea men o p e en ion o disease • A o as a in • Pa ace amol • T as uzumab Medical de ices A icle, ins umen , appa a us o machine ha is used in he p e en‑ ion, diagnosis o ea men o illness o disease, o o de ec ing, measu ing, es o ing, co ec ing o modi ying he s uc u e o unc‑ ion o he body o some heal h pu pose [11]. • D ug elu ing s en • Wea able ca dio e e ‑de ib illa o Heal h p oduc s/ Disposables I ems designed o single use o hose ha may be used mo e han once a e p ope cleaning and s e i‑ lisa ion and/o disin ec ion [12]. • Glucose es s ips Pe sonnel Labou ime o heal h ca e p o es‑ sionals (e.g., wo ke s employed in heal h ca e ins i u ions o p ocesses). • Gene al p ac i ione • Nu se • Specialis Composi e goods and se ices Ou pa ien isi Visi o a pa ien who is no hospi al‑ ized o e nigh bu who isi s a hospi al o clinic o diagnosis o non‑su gical ea men [13]. Home isi s (medical o nu sing s a a ending a pa ien a his home) and Acciden and Eme gency isi s we e also conside ed. • Gene al p ac i ione isi • Specialis isi • Acciden & Eme gency isi Hospi aliza ion Admi ance o he hospi al as an inpa ien [13]. • Day o hospi aliza ion a “no mal” wa d • Day o hospi aliza ion a In ensi e Ca e Uni Image diagnosis Radiog aphy, sonog aphy, and o he echnologies used o c ea e a g aphic depic ion o he body o diagnosis o he apeu ic pu poses [13]. • Ul asound scan • Compu e ized Tomog aphy Scan Labo a o y es s Se ices p o ided by medical labo a o ies o he diagnosis o disease [13]. • C ea inine • Fe i in Ambulance se ice Se ice p o ided by a ehicle which can anspo medical pa ien s o he ea men si e o back o hei place o esidence, and in some ins ances will also p o ide ou ‑o ‑ hospi al medical ca e o he pa ien du ing he anspo a ion. • Non‑eme gency pa ien anspo • In ensi e ca e ambulance Diagnos ic p ocedu es Type o es used o help diagnose a disease o condi ion [14]. • Colonoscopy The apeu ic p ocedu es Medicine o he apy used o cu e disease o pain by he in ol emen and in e cession o p oac i e, he a‑ peu ic p ac ice [15]. • Haemodialysis • Oxygen he apy Page 4 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 hese i ems and any accompanying publicly a ailable documen s desc ibing he cos -accoun ing me hodology used o cons uc hem. These we e ob ained om web- si es o heal h au ho i ies and heal h minis ies in each coun y. These sou ces o ma e ial a e lis ed in Supple- men a y Ma e ial. Valida ion o da a The conso ium pa ne s (London School o Econom- ics, Bocconi Uni e si y o Milan, Ins i u e o Economic Resea ch o Slo enia, Assis ance Hôpi aux Publique de Pa is (AP-HP), Ins i u o Supe io Técnico (IST) o Po - ugal, Den al and Pha maceu ical Bene i s Agency (TLV) o Sweden, Agency o Heal h Technology Assessemen and Ta i Sys em (AOTMiT) o Poland and Uni e si y o Biele eld o Ge many) e i ied his ma e ial and p o ided e e ences o any addi ional ele an da abases and docu- men a ion. All documen a ion was ansla ed o English wi h he assis ance o online ools and conso ium pa - ne s. An online wo kshop was o ganized a he end o Oc obe 2019 whe e one conso ium pa ne om each coun y explained he unc ioning o hei espec i e na ional da abase and p o ided any commen s on he cos ing me hodology. Conso ium pa ne s checked and alida ed he inal selec ion o da a i ems be o e inclusion in he EU HCSCD. Annual a e o change ina e age p ice le els in hecoun y We upda ed alues o 2019 p ices using G oss Domes ic P oduc (GDP) de la o [17] and Consume P ice Index (CPI) [18] o each coun y. The WHO-CHOICE guide o cos -e ec i eness analysis ecommended using GDP p ice de la o s (wi h he CPI measu e being he nex bes al e na i e) [19, 20]. GDP de la o o CPI a e used o upda e p ices and cos s o he cu en yea in he local cu ency. Con e sion o local p ice in oeu os The con e sion is based on a es aken om he Eu o- pean Cen al Bank webpage [21] and is made as ollows. The uni p ice o a pa icula medical p ocedu e co e- sponding o le us say England yea 2014 is in oduced in he da abase in local cu ency, in his case in B i ish pound. The con e sion o eu os is made acco ding o he las con e sion a e in oduced in he da abase o he same yea , which is he las day o Decembe . In case in some coun y a cos o a cu en yea needs o be in o- duced in he EU HCSCD, he con e sion a e o ha coun y co esponds o 1s Janua y o he same yea . A he end o he yea , his con e sion a e is upda ed o he las day o he same yea and all cos s co esponding o ha yea a e au oma ically upda ed. No e ha local p ice and p ice in eu o e e o he same yea . Access anduse o  heda abase The ee-access da abase is a ailable a h ps:// www. easp. es/ Impac - H a/ de au l [5]. The e a e wo op ions: heal h- ca e cos and social cos . Click on heal hca e cos and hen click on ‘Go o he Cos Da abase’. Th ee sea ching s a egies ha e been de ined: basic sea ch, iew all cos s and ad anced sea ch. Basic sea ch consis s o sea ch- ing he yped wo d ac oss he ield ‘I em’. E.g., i a use ypes ‘gene al p ac i ione ’, he da abase will epo all he i ems con aining ‘gene al p ac i ione ’. Toge he wi h he sea ched i em, se en addi ional ields a e displayed: I em sub ype, Uni o measu emen , Yea , Coun y, P ice in eu o, P ice in eu o (GDP De la o applied) and P ice in eu o (CPI applied). All he in o ma ion ega ding a pa icula cos ing i em is displayed a e clicking on he bu on ‘ iew’. This has o be done o i em sepa a ely. To isualize all he in o ma ion o all he i ems ound, he use s can selec all hese i ems and hen click on ‘expo cs ’. The sea ch op ion ‘ iew all cos s’ allows use s o isu- alize all cos s in oduced in o he da abase. The modali y Table 1 (con inued) Ca ego y Subca ego y De ini ion Cos ing i ems Complex p ocesses and in e en‑ ions Inpa ien medical and su gical p ocesses Requi e pa ien s o s ay he nigh ollowing he su ge y. • Hea ailu e (ICD10: 50) • He nia inguinal, emo al, umbilical (ICD10: K40, K41; K42) Day case p ocedu es/ Ou pa ien su ge y Day case e e s o a pa ien o case ha comes in o hospi al o a su gi‑ cal p ocedu e and is deal wi h and eleased in he cou se o one day [16]. Ou pa ien su ge y e e s o usually mino in asi e in e en ions pe o med on ambula o y pa ien s usually in a clinic o consul ing oom. • Lapa oscopic cholecys ec omy • Ca a ac ex i pa ion Page 5 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 Table 2 Examples o cos ing i ems included in he Eu opean Heal hca e and Social Cos Da abase (EU HCSCD) Field Desc ip ion Example1 Example2 Example3 Ca ego y P ima y esou ces Composi e goods and se ices Complex p ocesses and in e en ions Subca ego y Medical de ices Image diagnosis Inpa ien medical and su gical p o‑ cesses Cos ing i em Wea able ca dio e e ‑de ib illa o Compu e ized omog aphy scan Hea ailu e (ICD10: I50) I em sub ype P o ides u he desc ip ion o he cos ing i em. n.a. Scan o he skull and i s con en s, wi hou con as medium Ve y complex I em in local language Apa om English, each i em is p o‑ ided in he language o he coun y he esou ce is aken om. De ib illa o e Indossabile Scanog aphie du c âne e de son con enu, sans ijec ion de p edui de con as e Hjä s ik & chock Code Combina ion o le e s and/o num‑ be s each cos ing i em is desc ibed wi h in he o iginal sou ce. Z12030503 ACQK001 E47A Model Value used o ep esen one medical de ice o a amily o medical de ices o g oup many a ia ions ha ha e sha ed cha ac e is ics. This ield applies o medical de ices and heal h p oduc s/disposables. WCD‑4000 n.a. n.a. B and P op ie a y/comme cial name occasionally used o assis in he iden i ica ion o he egula ed medical de ice and/ o disposables/ eus‑ able. This ield applies o medicines, medical de ices and heal h p oduc s/ disposables. Zoll Medical I alia SRL n.a. n.a. Coun y The coun y he da a o igina ed om. I aly F ance Sweden Region Sa dinia n.a. Ös e gö land Type o uni The way he uni s a e deli e ed (e.g., box). This ield applied o medicines and heal h p oduc s/ disposables. n.a. n.a. n.a. Numbe o uni s The numbe o i ems deli e ed in he yea o obse a ion ha a e included in uni p ice. The pu pose o his ield is o know how eliable a ce ain alue –usually an a e age − is. 1 1 1 Uni o measu emen The uni ha can be acqui ed a an obse able p ice o he uni ha is used by each heal h ca e cen e/ hospi al. Wea able ca dio e e ‑de ib illa o (WCD) P ocedu e P ocess S eng h The amoun o a d ug in a gi en dos‑ age o m, measu ed as he numbe o mic og ams pe millili e. This ield applies only o medicines. n.a. n.a. n.a. Page 6 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 Table 2 (con inued) Field Desc ip ion Example1 Example2 Example3 Yea Re e s o he yea o cos publica ion. 2019 2018 2019 Local p ice The uni p ice o each i em. 3700 25.27 72,198 Local cu ency The cu ency o he uni p ice o he coun y he i ems e e s o. Eu o Eu o Swedish k ona P ice in eu os Local p ice con e ed in o eu os. 3700 25.27 6909.35 Yea (GDP de la o ) Yea o he las GDP de la o a ailable. The GDP de la o is coun y‑speci ic, bu he las alue a ailable comes om he same yea . n.a. 2019 N.a. Local p ice (GDP de la o applied) Local p ice a e applying he las coun y‑speci ic GDP de la o a ail‑ able. 3700 25.58 72,198 P ice in eu os (GDP de la o applied) Local p ice (GDP de la o applied) con e ed in o eu os. 3700 25.58 6909.35 Yea (CPI) Yea o he las CPI a ailable. The CPI is coun y‑speci ic, bu he las alue a ailable comes om he same yea . n.a. 2019 n.a. Local p ice (CPI applied) Local p ice a e applying he las coun y‑speci ic CPI a ailable. 3700 25.60 72,198 P ice in eu o (CPI applied) Local p ice (CPI applied) con e ed in o eu os. 3700 25.60 6909.35 Type o uni alue Type o mone a y alue ha is placed on each o he esou ces used. Leasing p ice a i Ta i Type o ins i u ion Type o cen e whe e he pa ien s we e a ended. Hospi al Ambula o y ca e Hospi al Sou ce o uni cos da a The ins i u ion ha published he da a, ha is, he ins i u ion esponsible o communica ing o publishing he cos ing in o ma ion. Sis ema Sani a io Regione Sa degna Secu i é Sociale l’Assu ance Maladie Sydös a sjuk å ds- egionen Re e ence o uni cos da a A web page whe e he publica ion, epo o da abase wi h he uni cos is men ioned. h ps:// www. aob o zu. i / docum en i/9_ 204_ 20190 124111 h ps:// www. ameli. / accue il‑ de‑ la‑ ccam/ index. php h ps:// plus. jl. se/ in op age. js ? nodeld= 41089 Page 7 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 Table 2 (con inued) Field Desc ip ion Example1 Example2 Example3 No es Con ains any explana ions o no es ele an o he cos ing me hodology, i a ailable (i.e. wha cos elemen s a e included in he uni cos , how a e hese elemen s iden i ied –mic o‑ cos ing o g oss‑cos ing−, how a e cos elemen s alued – op‑down o bo om‑up−, e c. Cos pe 1‑mon h lease. The code e e s o CND (Classi icazione Nazionale dei Disposi i i medici). Consul a ion cos is no included. Paye ’s pe spec i e. The e a e he ollowing ex a cha ges: 40€ i he p ocedu e is pe o med u gen ly on Sundays and public holidays, 80€ o paedia ic nigh u gency 12–8 am, 50€ o eme gency excep paedia i‑ cians, + 49% o pa ien s < 5 yea s old, + 15.8% o majo ac adiog aphy ca ‑ ied ou by a adiologis , a pulmonolo‑ gis o a heuma ologis . The a i is based on DRG. Cos ing me hodology used in iden i ica ion and alua ion o esou ces: op‑down mic o‑cos ing. Dep ecia ion o build‑ ing and inancial cos a e included. Resea ch cos and eaching cos a e excluded. GDP G oss Domes ic P oduc , CPI Consume P ice Index Page 8 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 ‘ad anced sea ch’ is sui able o hose use s who wan o sea ch ac oss he pa icula ields o in e es . By clicking on ‘ad anced sea ch’, all he ields ela ed o a pa icula cos i em a e displayed. Main enance o  heda abase Ampli ying he numbe o cos ing i ems and upda ing he cos s in he u u e yea s a e issues ha need o be dis- cussed. E en hough all he cos s can be upda ed wi h GDP de la o o CPI in u u e yea s; his would be u ile and would quickly make he da abase i ele an . The only way he da abase will emain ele an is i he cos s a e subs i u es by hei ac ual alues om he ac ual sou ce da a each ime hey a e upda ed in he o iginal sou ces. E en he unding om he Eu opean Union’s Ho izon 2020 esea ch and inno a ion p og am (g an ag eemen No 779312) expi ed by he end o June 2021, he e is s ill a need o ha ing such a da abase. The eam membe s a e cu en ly sea ching o mo e unding in o de o main- ain he da abase. I unding becomes a ailable, all use s would p opose amendmen s (e.g., upda es o i ems o addi ional i ems). Those use s ha apply o i (ideally a couple o hem om di e en coun ies) will ha e he powe o submi he da a o he da abase. The p incipal adminis a o (a pe son om he IMPACT-HTA p ojec eam) will be in cha ge o e ising hem and making he upda es pe iodically. All changes will be no i ied o he use s by email. Those use s wishing o be in he mail lis can send an email o he P incipal In es iga o P o es- so Jaime Espín (jaime@ easp. es). Each ime a new i em is p oposed, subsc ibed use s will ecei e a no i ica ion on sea ching o ha i em in hei coun y and send i o he abo e con ac . Once his new i em is in oduced in o he da abase, he use s will ecei e a no i ica ion. In he absence o inancing, he au ho s p opose ha a commu- ni y o olun ee s (use s) h ough a model o open col- labo a ion main ains he da abase. This is a Be a e sion, which is being eleased now o es ing and eedback om he heal h economic commu- ni y o in o m u he de elopmen and main enance, he e o e any commen s and sugges ions om use s a e welcomed. Anyone is ee o use he da a wi hou es ic- ion, bu a e asked o ci e his a icle. Discussion S eng hs andlimi a ions The EU HSCSD has been cons uc ed wi h he aim o imp o ing anspa ency, gene alizabili y and ans e - abili y o economic e alua ions. This esou ce should help esea che s o ind uni cos da a quickly, cheaply and accu a ely. I has been de eloped wi h a use - iendly design and is ela i ely simple o manage and upda e. Whe e cu en yea da a a e una ailable, i upda es cos s using CPI and GDP de la o s [19]. Links a e p o ided o he o iginal sou ces o in o ma ion. The e o e, e en i a esea che needs da a o some i em ha has no been in oduced in o he da abase so a , he o she can ind i in he o iginal sou ce. The EU HCSCD also p o ide an use ul inpu o s anda dized uni cos empla es o a mul i-sec o al se ice and esou ce use measu emen ins umen de eloped as pa o PECUNIA p ojec o ensu e c oss-coun y compa abili y and ans e abili y [22]. Uni cos da a ha e se e al limi a ions ha need o be bo ne in mind when compa ing alues ac oss coun ies o conside ing which alues a e app op ia e as inpu s o economic e alua ions. As desc ibed elsewhe e [23, 24], no all coun ies p o ide o icial uni cos s o all i ems, and ew coun ies p o ide anspa en documen a ion on which ypes o esou ces a e included in he o al cos o how hose alues we e es ima ed. Many ‘p ima y esou ces’ a e likely o be de ined in a ai ly s anda d way ac oss coun ies, o example: medi- cines by name and composi ion, de ices by manu ac u e and model. Heal hca e p o essionals may be mo e com- plica ed. Heal h p o essionals o he same g ade may ha e qui e di e en unc ions, o example, in some coun ies; a senio doc o has a dedica ed pe cen age o ime o adminis a ion, a el o esea ch, bu no in o he coun- ies. In some coun ies, nu ses can ake senio oles ( o example, he “consul an nu se” in he Uni ed Kingdom), in o he coun ies hei ole is mo e es ic ed. O he a ia ion a ises in he uni o measu emen o he sou ce ( o example: cos pe hou , mean cos pe pa ien pe yea ) o ype o expenses included ( o example: a el o aining). Sala ies in he heal h se ice may no be “ma - ke p ices” ( ha is, e lec ing ela i e sca ci y) bu a e o en de e mined by o he ac o s, such as labou union nego ia ions, na ional legisla ion, wo ke s’ senio i y, and so on [25–28]. Rega ding accessibili y o cos da a, cu en da abases o o icial p ices o medicines we e ound in each coun y, hough wi h some he e ogenei y in de ini ion. The o icial “public” p ice is published in England, F ance, Poland, Po ugal and Sweden. In Ge many, Spain and Slo enia, he e e ence p ice is published, while in I aly, i is he ex- ac o y p ice [29]. Cos s o medical de ices, heal h p od- uc s and disposables we e mo e di icul o ob ain and he da a a ailable we e a ely up- o-da e. The compa ison o cos s o medicines, medical de ices and heal h p od- uc s is hampe ed by he a ie y o b ands and models. The p ices quo ed o medical de ices and heal h p od- uc s included leasing p ice, ex- ac o y p ice, public p ice, pu chase p ice, e e ence p ice and wholesale p ice. ‘Complex p ocesses and in e en ions’ e e s o inpa- ien and ambula o y su gical p ocedu es. In some Page 9 o 10 Espíne al. BMC Heal h Se ices Resea ch (2022) 22:405 coun ies, cos s o ambula o y p ocedu es can be ound in he same da abase as hospi al admissions. Fo example, in England some ambula o y p ocedu es a e classi ied as Diagnosis-Rela ed G oups (DRGs) (whe e hey a e called “day-case admissions”) o , as in Sweden, he e is a close ela ionship be ween DRG cos s and cos s o ambula- o y p ocedu es. In some coun ies, a i s a e published o ambula o y p ocedu es, bu no cos s (Po ugal, I aly, Spain). In I aly, a i s a e published a na ional and p o- incial le els, while in Spain, he e a e only p o incial a i s. In F ance, Ge many, Poland and Slo enia, some ambula o y p ocedu es ha e DRG cos s, while o he s a e only a ibu ed a a i . The me hodology o cos ing DRGs is o en eason- ably well documen ed, hough he e a e some gaps and unce ain ies, especially a ound he ea men o o e - heads [23]. I is usually less clea how he cos s o a - i s o o he ypes o composi e se ices and complex in e en ions we e calcula ed and wha esou ces we e included. Fo example, a labo a o y es is a se ice ha includes some consumables, along wi h labo a o y ech- nician ime, adminis a ion, communica ion o esul s o he pa ien , e c. The a i o a gi en es ( o example, a c ea ine es ) migh a y depending on whe he i is p o- ided in a hospi al o in a p ima y ca e clinic. Ano he example is an ou pa ien consul a ion. The cos o a i may a y, depending on whe e i akes place, whe he es s and ea men s a e included o no , and he ype o p o essional. The cos o an ambulance se ice a end- ance may di e ac oss coun ies because o he uni o measu emen (pe jou ney, pe in e en ion, pe kilome- e, pe pa ien /yea , pe mobile uni /yea , pe hou ), o he ype o se ice (u ban, in e u ban, anspo o dialy- sis, and so on). The cos o adiog aphic imaging may depend on he du a ion, whe he con as was used, he numbe o a eas, whe he he pa ien accessed di ec ly o he se ice o was e e ed by his o he p ima y ca e doc o and so on. Conclusions The EU HCSCD is he only public uni heal hca e and social cos da abase a Eu opean le el. The p ojec eam a e ac i ely wo king owa ds se ing up a s able conso - ium esponsible o imp o ing, upda ing and ensu ing he con inui y o he EU HCSCD. Na ional go e nmen s o s a is ical agencies should e iew hei cos ing me h- ods in heal hca e and ensu e ha hey mee bes p ac ice [30, 31]. We also ecommend he c ea ion o a Eu opean Union Task Fo ce o pe iodically e ise na ional heal h- ca e classi ica ion and cos ing me hodologies a EU le el and wo k owa ds ha moniza ion and s anda diza ion whe e possible. Abb e ia ions EU HCSCD: Eu opean Heal hca e and Social Cos Da abase; EE: Economic E alua ion; HTA: Heal h Technology Assessmen ; DRGs: Diagnosis‑Rela ed G oups; GDP: G oss Domes ic P oduc ; CPI: Consume P ice Index. Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h ps:// doi. o g/ 10. 1186/ s12913‑ 022‑ 07791‑z. Addi ional ile1. Acknowledgemen s The au ho s a e e y hank ul o Emilia Ramos‑Gale a o so wa e de elop‑ men o he da abase. Au ho s’ con ibu ions ZS, LGM, AOL, JR and JE pa icipa ed in he de elopmen o he da abase. ZS sea ched o uni cos s, uploaded hem in he da abase and w o e he a icle. ZS and DE analysed me hodology used in es ima ion o uni cos s. All au ho s c i ically e ised he manusc ip and ga e he inal app o al o he e sion o be published. Funding This s udy has ecei ed unding om he Eu opean Union’s Ho izon 2020 esea ch and inno a ion p og amme unde G an ag eemen no. 779312. A ailabili y o da a and ma e ials All da a a e a ailable a h ps:// www. easp. es/ Impac ‑ H a/. Decla a ions E hics app o al and consen o pa icipa e No applicable. Consen o publica ion No applicable. Compe ing in e es s The au ho s decla e ha hey ha e no con lic o in e es . Au ho de ails 1 Andalusian School o Public Heal h/Escuela Andaluza de Salud Pública (EASP), Cues a del Obse a o io 4, 18011 G anada, Spain. 2 CIBER en Epidemi‑ ología y Salud Pública (CIBERESP), Spain/CIBER o Epidemiology and Public Heal h (CIBERESP), Mad id, Spain. 3 Ins i u o de In es igación Biosani a ia ibs, G anada, Spain. 4 Uni e si y o G anada, G anada, Spain. Recei ed: 25 May 2021 Accep ed: 16 Ma ch 2022 Re e ences 1. Sculphe M, Pang F, Manca A, D ummond M, Golde S, U dahl H, e al. Gene alisabili y in economic e alua ion s udies in heal hca e: a e iew and case s udies. Heal h Technol Assess (Rock ). 2004. h ps:// doi. o g/ 10. 3310/ h a84 90. 2. D ummond M, Manca A, Sculphe M. Inc easing he gene alizabili y o economic e alua ions: ecommenda ions o he design, analysis, and epo ing o s udies. In J Technol Assess Heal h Ca e. 2005;21(2):165–71. 3. Swedish Council on Heal h Technology Assessmen (SBU) / Sweden. Me hods o heal h economic e alua ions. Eu opean Ne wo k o Heal h Technology Assessmen . 2015. h ps:// www. eune h a. eu/ wp‑ con e n / uploa ds/ 2018/ 03/ Me ho ds_ o _ heal h_ econo mic_ e alu a ions. pd . Accessed 1 Ma 2022. 4. Ga cía‑Mochón L, Ro i a Fo ns J, Espin J. Cos ans e abili y p oblems in economic e alua ion as a amewo k o an Eu opean heal h ca e and