title: An estimate of the cost of administering intravenous biological agents in Spanish day hospitals.
abstract: OBJECTIVE
  To estimate the unit costs of administering intravenous (IV) biological agents in day hospitals (DHs) in the Spanish National Health System.
  
  
  METHODS
  Data were obtained from 188 patients with rheumatoid arthritis, collected from nine DHs, receiving one of the following IV therapies: infliximab (n=48), rituximab (n=38), abatacept (n=41), or tocilizumab (n=61). The fieldwork was carried out between March 2013 and March 2014. The following three groups of costs were considered: 1) structural costs, 2) material costs, and 3) staff costs. Staff costs were considered a fixed cost and were estimated according to the DH theoretical level of activity, which includes, as well as personal care of each patient, the DH general activities (complete imputation method, CIM). In addition, an alternative calculation was performed, in which the staff costs were considered a variable cost imputed according to the time spent on direct care (partial imputation method, PIM). All costs were expressed in euros for the reference year 2014.
  
  
  RESULTS
  The average total cost was €146.12 per infusion (standard deviation [SD] ±87.11; CIM) and €29.70 per infusion (SD ±11.42; PIM). The structure-related costs per infusion varied between €2.23 and €62.35 per patient and DH; the cost of consumables oscillated between €3.48 and €20.34 per patient and DH. In terms of the care process, the average difference between the shortest and the longest time taken by different hospitals to administer an IV biological therapy was 113 minutes.
  
  
  CONCLUSIONS
  The average total cost of infusion was less than that normally used in models of economic evaluation coming from secondary sources. This cost is even less when the staff costs are imputed according to the PIM. A high degree of variability was observed between different DHs in the cost of the consumables, in the structure-related costs, and in those of the care process.
authors.affiliation: Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona.
authors.forename: Joan Miquel
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Hospital Universitario de Getafe, Madrid.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Martín
authors.affiliation: Hospital Universitario Fundación Jiménez Díaz, Madrid.
authors.forename: Pilar
authors.initials: P
authors.lastname: Llamas
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza.
authors.forename: Javier
authors.initials: J
authors.lastname: Manero
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona.
authors.forename: Arturo
authors.initials: A
authors.lastname: Rodríguez de la Serna
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Santander.
authors.forename: Manuel Francisco
authors.initials: MF
authors.lastname: Fernández-Miera
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Santander.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Hospital Universitario Virgen del Rocío, Sevilla.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: López
authors.affiliation: Max Weber Institute, Madrid.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: MSD, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Aragón
keywords: care process; day hospitals; intravenous biological agents; rheumatoid arthritis; unit cost of infusion; variability