Determining costs in VA - Research design problems and solutions illustrated with case studies

BACKGROUND. Department of Veterans Affairs (VA) administrative cost data ba ses contain inaccuracies and do not provide patient-level data. OBJECTIVE. TO describe methods of VA cost determination that are appropriat e for specific types of studies and to exemplify these methods with case st udies. RESEARCH DESIGN. VA utilization and cost data sources are described, and th eir limitations highlighted. Strategies for determining costs are discussed for health care that is critical to the study, for other types of health c are, and for new programs or interventions. Three case studies are presente d to illustrate cost-finding methods. RESULTS. A hybrid approach to determining VA costs is discussed. For health care that is critical to the study, administrative data can be replaced or supplemented with primary data, information from the fiscal or other servi ces, or non-VA data. Primary data are also needed to evaluate new programs or interventions. Less intensive data gathering methods can be used for hea lth, care that is not central to the study. The first case study illustrate s cost determination for a randomized controlled trial, using an example of alternative ways of maintaining hemodialysis access graft patency, The sec ond case study illustrates the determination of costs for all outpatient pr ocedures to use in billing for veterans with private health insurance, The third case study describes the estimation of cost savings from regionalizin g open heart surgery. CONCLUSIONS. Despite problems with VA administrative cost data, accurate VA costs can be determined.