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A general framework for classifying costing methods for economic evaluation of health care


According to the most traditional economic evaluation manuals, all “relevant” costs should be included in the economic analysis, taking into account factors such as the patient population, setting, location, year, perspective and time horizon. However, cost information may be designed for other purposes. Health care organisations may lack sophisticated accounting systems and consequently, health economists may be unfamiliar with cost accounting terminology, which may lead to discrepancy in terms used in the economic evaluation literature and management accountancy. This paper identifies new tendencies in costing methodologies in health care and critically comments on each included article. For better clarification of terminology, a pragmatic glossary of terms is proposed. A scoping review of English and Spanish language literature (2005–2018) was conducted to identify new tendencies in costing methodologies in health care. The databases PubMed, Scopus and EconLit were searched. A total of 21 studies were included yielding 43 costing analysis. The most common analysis was top-down micro-costing (49%), followed by top-down gross-costing (37%) and bottom-up micro-costing (14%). Resource data were collected prospectively in 12 top-down studies (32%). Hospital database was the most common way of collection of resource data (44%) in top-down gross-costing studies. In top-down micro-costing studies, the most resource use data collection was the combination of several methods (38%). In general, substantial inconsistencies in the costing methods were found. The convergence of top-down and bottom-up methods may be an important topic in the next decades.

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Fig. 1

Source: own elaboration


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This study is a part of the Work Package 3 Developing a costing methodology and a core dataset of costs for facilitating cross border comparisons in economic evaluation framed in the IMPACT-HTA and sponsored by the European Union’s Horizon 2020 research and innovation programme (Grant number 779312) and is conducted by the Andalusian School of Public Health (EASP). EASP team thanks Alistair McGuire, Wolfgang Greiner, Isabelle Durand-Zaleski and Valentina Katka Rupel for valuable comments and suggestions on earlier draft of the paper.


This study has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant agreement no. 779312.

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Correspondence to Jaime Espín.

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Špacírová, Z., Epstein, D., García-Mochón, L. et al. A general framework for classifying costing methods for economic evaluation of health care. Eur J Health Econ (2020). https://doi.org/10.1007/s10198-019-01157-9

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  • Costing methodology
  • Economic evaluation
  • Top-down method
  • Bottom-up method
  • Micro-costing
  • Activity-based costing

JEL Classification

  • A12
  • I10