OBJECTIVES:

The comparative analysis of a novel intervention’s cost-effectiveness across jurisdictions is predicated on the existence of comparable measures of cost and outcome. More than 10 years after the Centre for Health Economics at York published a review of methods for estimating the cost of healthcare services considerable heterogeneity remains in the reporting of costs. We compare the estimated cost of the most commonly accessed service - general practitioner services - to demonstrate the degree of heterogeneity and explore the sources and implications of that heterogeneity for cost-effectiveness analysis conducted across jurisdictions.

METHODS:

A literature review was undertaken to identify the cost of a GP consultation used in health technology assessments. To minimise heterogeneity related to differences in national income, only countries listed among the high-income group by the World Bank were selected for inclusion in the review. The cost of a GP consultation in 20 countries was obtained from published literature located through Pubmed. All costs were adjusted for inflation to their 2015 equivalent and converted to Irish Euro € using the OECD’s PPP conversion rates.

RESULTS:

Among the 20 countries for which GP consultation costs were found, the reported cost of a consultation ranged from €7 to €142. The mean cost was €46 with a standard deviation of €36. Cost estimates varied in antiquity from 2007 to 2015. A positive weakly significant correlation was observed between GP costs and a country’s per capita GDP.

CONCLUSIONS:

Evident heterogeneity in the cost of a GP consultation reflects more strongly methodological heterogeneity in the estimation of costs than variations in national income. Adapting model-based estimates of cost-effectiveness using local costs without considering the basis upon which costs are constructed will fail to produce comparable estimates of cost-effectiveness.