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A practical guide to episode groupers for cost-of-illness analysis in health services research

Review

Affiliations

• ¹ National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
• ² National Center for Birth Defects and Developmental Disabilities Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
• ³ Bureau of Economic Analysis, Washington, DC, USA.

• PMID: 30956790
• PMCID: PMC6444409
• DOI: 10.1177/2050312119840200

Item in Clipboard

Review

Cora Peterson et al. SAGE Open Med. 2019.

• ¹ National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
• ² National Center for Birth Defects and Developmental Disabilities Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
• ³ Bureau of Economic Analysis, Washington, DC, USA.

• PMID: 30956790
• PMCID: PMC6444409
• DOI: 10.1177/2050312119840200

Item in Clipboard

Despite the prominence of episode groupers for analysis and reimbursement in US payer settings, peer-reviewed articles using episode groupers for cost-of-illness analysis that informs public health research and decision-making are uncommon. This article provides a brief practical guide to episode-based cost analysis and offers some examples of episode grouper products. It is intended for an audience of health services researchers and managers in public health settings who perform or commission cost-of-illness studies with the US healthcare claims fee-for-service data but lack familiarity with episode groupers.

Keywords: Episode of care; costs and cost analysis; health expenditures; health services research; value-based purchasing.

PubMed Disclaimer

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

• Financial Margins for Prostate Cancer Surgery: Quantifying the Impact of Modifiable Cost Inputs in an Episode Based Reimbursement Model.

  Johnson DC, Kwok E, Ahn C, Pashchinskiy A, Laviana AA, Golla V, Rosenthal JT, Bravo F, Litwin MS, Saigal CS. Johnson DC, et al. J Urol. 2019 Sep;202(3):539-545. doi: 10.1097/JU.0000000000000283. Epub 2019 Aug 8. J Urol. 2019. PMID: 31009291

• Systematic Review of Per Person Violence Costs.

  Peterson C, Aslam MV, Rice KL, Gupta N, Kearns MC. Peterson C, et al. Am J Prev Med. 2024 Feb;66(2):342-350. doi: 10.1016/j.amepre.2023.08.009. Epub 2023 Aug 10. Am J Prev Med. 2024. PMID: 37572854 Free PMC article.

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