OBJECTIVES

: Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers to redesign reimbursement schemes, as well as for healthcare providers seeking to improve the outcomes-over-cost ratio, i.e., value, of their interventions. This systematic literature review aims to provide an overview of studies focusing on variability in treatment cost from the hospital perspective, providing an outline of their study characteristics, summarizing their cost drivers and offering suggestions on methodology for future research.

METHODS

: The review was conducted with adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions. PubMED/MEDLINE, Web of Science, EMBASE, Scopus, CINAHL, Science direct, OvidSP and Cochrane library were searched. Data was extracted and appraised by 2 investigators for citation until October 2020.

RESULTS

: A total of 90 eligible articles was included. Patient, treatment and disease characteristics and, to a lesser extent, outcome and institutional characteristics were identified as significant variables explaining cost variability. In one-third of the studies, the costing method was classified as unclear due to the limited explanation provided in the papers.

CONCLUSIONS

: A high variety of patient, treatment and disease characteristics was identified as common independent variables explaining hospital cost variability. The limited transparency on how hospital costs are defined is a remarkable observation for studies wherein cost variability is the main focus. Recommendations relating to the variables, costs, and statistical methods to consider when designing and conducting cost variability studies have been provided. These recommendations aim to fulfill the full potential of future research focusing on variability drivers of patient treatment costs in hospitals.