Standart Cost Article

Review

Prepared for:
Madam Susi Handayani, S.E., Ak., M.Ak., CA.
 GROUP 7
Member of the groups:

- Nadien Ayatilla 20080694037

- Farliza Atna Ayu Susanto 20080694056

- Rinasda Serena 20080694061

 Learning Objective
01 02
Background and Underlying Theory
Characteristic of the
Company

03
The Implementation of
Standart Costing
 01
Background and Characteristic of
the Company
 Background of Implementing Company

In developing countries, there is a knowledge gap on this subject, as the strategy of HF disease
management programs particularly those including a home visit (HV) component, which is an essential
determinant of effectiveness remains relatively unexplored. From this perspective, the present study sought
to estimate the cost-effectiveness of a nurse-led HV intervention as compared with the standard HF
management, within a randomized clinical trial in Brazil, a developing nation with major ethnic, cultural,
and health care–related differences from the populations evaluated in previous reports. In this protocol, the
primary outcome, a composite end point of a first visit to the emergency room, a hospital readmission, or
all-cause death, was decreased by 27% in the interventional group.
 Characteristic of Implementing Company

After we researched, in the article the characteristics of implementing companies related to research are as
follows:

1. Hospital companies in Brazil.

2. Hospitals that have a high number of heart failure patients.

3. Hospitals that are ready to provide home services through nurse calls and direct services at the

hospital.
 02
Underlying Theory
 Economic Evaluation

– To determine if the intervention is efficacious and how much the improvement cost.

– One of its four subtype is Cost Effectiveness Analysis (CEA).

 Cost Effectiveness Analysis

- A form of economic analysis that compares costs with the outcomes

(outputs) of two or more interventions.
- Decision can be made regarding the more cost-effective choice of
available resources.
- Doesn’t necessarily mean that the cheapest method is chosen
however. So, even though a healthcare intervention is costly, if it
significantly improves a healthcare outcome for patients, it is deemed
cost-effective.
- Measured in the same unit, by Incremental Cost-Effectiveness Ratio
(ICER)
 03
The Implementation of
Standart Costing
 Implementation

The results of the decision analysis model used herein showed that the study intervention (HVs with telephone reinforcement) was
associated with a favorable ICER within the scenario of the Brazilian PHS. After sensitivity analysis, the HV intervention proved
dominant considering half the value of the intervention (R$236) over 6 months, or twice the amount paid by a hospitalization (R$11,868).
Conversely, within the private health care system of Brazil, this intervention would be cost saving for payers up to a cost of R$467 per
patient. To our knowledge, this was the first cost-effectiveness study of a nurse-led, HV-based intervention for patients with HF
conducted in a developing country and nested within a randomized clinical trial.

In Brazil, values reimbursed by the PHS for emergency room visits are based on nationwide price setting and have not changed over the
last 10 years. Payments for emergency room visits are bundled into “packages” contracted between health care facilities and the
government for a certain number of episodes of care per month, regardless of patient or disease. For HF hospitalizations, closed values
are also considered regardless of the number of days of hospitalization. The amounts paid are changed only in cases in which the patient
is submitted for a specific procedure, enabling additional charging. Therefore, even though only 25% of the Brazilian population is
covered by private health insurance the author decided to present cost-effectiveness outcomes for this scenario as well.
In the present study, the cost of the nurse-led intervention was R$467 over 6 months for a 27% reduction in composite end point (hospital
readmission due to decompensation of chronic HF and all-cause death). Taking into account that patients in the usual care group were, on
average, admitted twice as often as those in the nurse-led management group and that the average cost of a single emergency department
visit in the private health care system is R$1,325, this intervention could mean a saving of approximately R$663 per patient to payers

In underdeveloped nations, infrequent implementation of such programs is attributable to the lack of data on their true cost-effectiveness.
The disease management strategy analyzed herein had never been tested in a developing country setting. Analysis suggests that
implementation of this program not only could benefit patients, but also provide a financial incentive to health administrators. This study
followed current methodological guidelines for health technologies assessment within the framework of the Brazilian PHS, and included
sensitivity analyses for a PHS scenario and from a private health care system perspective. Author chose to report ICERs calculated on the
basis of effectiveness data for a crude readmission outcome (emergency room visits), and although the results are consistent with the
international literature.
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