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ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions

Periodic Reporting for period 2 - PECUNIA (ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions)

Reporting period: 2019-07-01 to 2021-06-30

Rapidly ageing societies, growing populations and new health technologies have led to a dramatic increase in healthcare costs within the European Union (EU) and the future trend remains an upward one. Between 1972 and 2010, public health expenditure has risen from 4.5% to 8% of GDP across the EU. Especially chronic conditions, multi-morbidities and mental health issues pose a major financial burden to European healthcare systems. On the other hand, at least a quarter of the total direct cost impact of healthcare interventions affects other economic sectors, such as social care, education, the criminal justice system, employment and productivity.

The European research project PECUNIA (ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions) tackles this challenge by aiming to achieve better comparability, greater cost efficiency and higher level of optimisation in European healthcare provision. The PECUNIA consortium brings together ten partners* from six countries (DE, NL, UK, AT, ES, HU) with differing health care systems and economic evaluation landscapes coordinated by the Medical University of Vienna. Partners have multi-disciplinary academic backgrounds in medicine, public health, health economics, economics, health technology assessment, psychology and sociology.

The project’s vision is to improve the comparability and feasibility of cost and outcome assessment of healthcare interventions within and across European countries based on five specific main objectives. Objectives 1-4 focus on the development of internationally standardized, harmonized and validated multi-sectoral, multi-national and multi-person methods, tools and information for
1) self-reported resource use measurement (RUM),
2) reference unit cost valuation,
3) cross-country health utility assessment, and
4) patient-reported outcome measurement (PROM) of quality of life and wellbeing.
Objective 5 concerns the establishment of a plan for the sustainable maintenance and expansion of the PECUNIA methods and tools.

The project has been funded with €3 million by the European Commission's current Research Framework Programme Horizon 2020 to achieve these objectives between 2018 and 2020.

*PECUNIA partners at a glance are: AT: Medical University of Vienna (MUW), ES: Servicio Canariuo de la Salud (SESCS), Asociación Científica Psicost (Psicost), DE: Universitätsklinikum Hamburg-Eppendorf (UKE), European Research and Project Office GmbH (EURICE), HU: Corvinus University of Budapest (CUB), NL: Maastricht University (UM), Erasmus Universiteit Rotterdam (EUR), UK: London School of Economics (LSE), University of Bristol (UnivBris).
PECUNIA works alongside four sector-specific work packages (WP1-4) and four cross-sectoral horizontal activities (HA) to complete the harmonised Identification (HA1), Definition (HA2), Measurement (HA3) and Valuation (HA4) of costs in multiple sectors (health care, social care, criminal justice, education, productivity, patient and family) using selected mental disorders (depression, schizophrenia, post-traumatic stress disorder) as illustrative examples. Separate work packages are dedicated to Outcome assessment (WP5) and Validation (WP6). One additional WP focuses on Project management and integration (WP7) and one on Communication, and dissemination and exploitation (WP8). At the beginning of the project, an extensive concept paper was developed to establish harmonised terminology, develop a multi-sectoral costing concept, and outline a detailed work plan allowing the timely execution of all tasks.

In the first half of the project, several major milestones have been achieved. Firstly, two scoping reviews synthesising the current status of knowledge and evidence for the measurement and valuation of resources across multiple sectors have been conducted. Secondly, the comprehensive identification and definition of multi-sectoral services for comparative country reports were carried out based on sector-specific systematic literature reviews and country-level expert surveys in all six PECUNIA countries. During these steps we have identified many taxonomical and conceptual discrepancies between health services research and health economics which have so far hindered harmonized costing efforts and comparability in economic evaluations. To bridge this gap, the ‘PECUNIA care atom’, a new multi-sectoral conceptual costing framework, has been developed. In terms of outcome assessment, nouveau analytical methods for cross-country health utility assessment have been developed. Comprehensive synthesis of the broader mental health PROM landscape has also started using systematic literature review methods.

So far, 23 scientific presentations were held and 19 peer-reviewed publications are in the pipeline. Dissemination activities took place to a wide variety of stakeholder groups via 24 press releases, our dedicated PECUNIA website ( half-yearly e-newsletters and social media ( The 1st PECUNIA stakeholder workshop is planned for July 2019.
Work in the second half of the project will be closely based on the interim results achieved in months 1-18. Future steps towards harmonised costing methods will focus on the development and validation of a new, internationally standardised, harmonised and validated multi-sectoral RUM instrument and matching unit costing templates. Finally, a multinational electronic library of core resource and service reference unit costs will be established. To further the feasibility of multi-national, multi-sectoral and multi-person outcome assessment, different cross-country utility tariff sets will be developed applying the new analytical method and an electronic PROM library will be set up. Objective 5 will be addressed parallel.

Overall, the PECUNIA project results will lead to better understanding of the variations in costs and outcomes within and across countries, improve the quality, comparability and transferability of economic evaluations in Europe, and support the feasibility of broader economic and societal impacts measurement and valuation of healthcare interventions.