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Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities

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Abstract

This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis.

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Notes

  1. http://www.hscic.gov.uk/media/15698/DARS---Guidance-Notes-on-Security/pdf/Guidance_Notes_on_Security_v4.0_(1).pdf.

  2. Rules for identifying events from the CALIBER data platform can be found on the CALIBER data portal: https://www.caliberresearch.org/portal.

  3. http://apps.who.int/classifications/icd10/browse/2016/en.

  4. The classification of resource use into HRGs in England can be automated using the grouper tool produced by the NHS HSCIC (Health and Social Care Information Centre) and made available online. A grouper is produced for each year of data which applies the rules as defined in that year to derive the HRGs relevant for that year. http://www.hscic.gov.uk/article/2062/Archive-costing.

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Acknowledgments

Miqdad Asaria took overall responsibility for the paper and its structure and contributed the sections on handling sensitive data and extracting clinical endpoints. Katja Grasic was responsible for the section on costing practice and Simon Walker was responsible for the sections on costing principles and costing for economic models. All authors commented and contributed to all parts of the paper. The authors would also like to acknowledge Sam Brilleman from the University of Bristol and Tarita Murray-Thomas from CPRD for their help and advice regarding deriving costs from administrative datasets.

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  1. Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK

    Miqdad Asaria, Katja Grasic & Simon Walker

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  1. Miqdad Asaria
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  2. Katja Grasic
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Correspondence to Miqdad Asaria.

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No funding was received for this article. Miqdad Asaria, Katja Grasic and Simon Walker each declare that they have no conflicts of interest.

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Asaria, M., Grasic, K. & Walker, S. Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities. PharmacoEconomics 34, 155–160 (2016). https://doi.org/10.1007/s40273-015-0358-8

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