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
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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
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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
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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
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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
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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.

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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
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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