Health economic reference cases and costing approaches – concepts, international practices and implications for Austria

Strohmaier C, Erdos J
Record ID 32018015607
English
Authors' objectives: Standardised cost and resource data are crucial for Health Technology Assessment (HTA) and healthcare planning. While many countries have national health economic guidelines, Austria lacks a consensus on a health economic reference case and costing standards.
Authors' results and conclusions: Costing universally involves identification, measurement, and valuation, with the chosen perspective (e.g., healthcare, societal) being the primary determinant of cost inclusion. The analysis of 12 countries with detailed guidelines reveals a high level of methodological maturity and consensus on core principles like uncertainty analysis. However, significant divergence exists in practice. While bottom-up micro-costing is the gold standard, most countries adopt a pragmatic top-down approach, except the Netherlands which mandates "micro-costing first". Perspective choice creates three clusters: strict healthcare (e.g. Australia), social health insurance (Germany), and comprehensive societal (e.g. the Netherlands). The Netherlands is unique in formally including cross-sectoral costs like education and justice. Valuation is predominantly tied to national tariffs or specific unit costs.
Authors' recommendations: International guidelines offer a framework of methodological flexibility for Austria. The central decisions involve the politically charged choice of perspective and the definition of relevant costs. This report provides a foundation for developing an Austrian reference case, with next steps including an analysis of national cost data sources to inform a formal guideline development process.
Authors' methods: This project analysed health economic guidelines, costing manuals, and HTA documents from 59 countries using a multi-stage approach based on ISPOR guidelines and systematic reviews. Data on reference case characteristics and detailed costing processes were extracted and synthesised narratively and in tables.
Details
Project Status: Completed
Year Published: 2026
URL for additional information: https://eprints.aihta.at/1601
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Austria
MeSH Terms
  • Cost-Benefit Analysis
  • Economics, Medical
  • Costs and Cost Analysis
Keywords
  • Health economics
  • reference case
  • costing
  • unit cost
  • valuation
Contact
Organisation Name: Austrian Institute for Health Technology Assessment
Contact Address: Josefstaedter Strasse 39, A-1080 Vienna, Austria
Contact Name: office@aihta.at
Contact Email: office@aihta.at
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.