OBJECTIVES: Hospital budget impact models can be simpler to build than cost-effectiveness models; however, they can be more complicated to inform given challenges with data availability, various decision-maker perspectives, and complexities around interpretation of costs, charges, and reimbursement. This study evaluates the strengths and weaknesses of two costing approaches used for economic evaluation related to image guidance in left atrial appendage occlusion (LAAO) procedures.

METHODS: A budget impact model was built comparing utilization of two imaging techniques to guide LAAO procedures, intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE). Procedure resources included devices, procedure time, supplies, pharmacy, hospital stay, anaesthesia, complications, and professional fees.

RESULTS: When using published data for the costing approach, key strengths included ease of accessibility and the ability to ensure data are relevant to the comparators. However, significant limitations included the inability to disaggregate some cost data and challenges with combining the data sources across different studies. A top-down costing approach using the Premier Healthcare database ensured data were available from one overall costing source for TEE and ICE, that all relevant hospital costs could be included, and that costs could be disaggregated by department level. Key challenges with using this database included the need to adjust for potential confounders as well as ensuring data were all specific to the comparators and procedure of interest (e.g., not including concomitant procedures). The corroboration of using these two approaches as well as the implications of the limitations will be discussed.

CONCLUSIONS: Using more than one costing approach can help validate predictions for a hospital budget impact model as each approach can have its own strengths and weaknesses. When presenting a budget impact model to a hospital decision-maker, it is essential to have well-informed default values to facilitate understanding and local adaptation.