OBJECTIVES : High-cost diseases pose challenges to healthcare systems financing; hence, it becomes relevant to develop methodologies to detect health benefits associated with cost increments. In that line, our study aims to describe the costs increments associated with selected health benefits in Uruguay by analyzing a health claims database.

METHODS : The 2018 report of a nationwide health claims database was analyzed in order to determine the fraction of patients receiving in high-cost health benefits in five areas: Cardiology, nephrology, transplantations, traumatology and otorhinolaryngology. High-cost patients were defined as those incurring in costs greater than two standard deviations within a given area. Patient data were also clustered using the PAM (Partition Around Medoids) algorithm in order to identify differences and similarities within patient claims and cost profiles.

RESULTS : 23850 registries corresponding to 19758 patients were analyzed. Most of the patients (54.85%) received cardiology benefits. Average patient age was 65.66 years and more than half of them were men (53.03%). Transplantation benefits were the ones associated with the highest average cost (US $23,801); however, only 1,0% of the patients receiving these benefits were associated with significant high-cost. In contrast, 9,6% and 2,5% of the patients receiving cardiology and traumatology benefits, respectively, were associated with significant high-cost. Age group and benefits area were the variables that better grouped the patient cohort.

CONCLUSIONS : Analysis of cost outliers is crucial for healthcare providers in order to identify sources of cost increments and can be used for routine commissioning of health services.