The Challenge of Unit Cost Harmonisation: A French National Reference Unit Cost for Healthcare Services (the MOVIE Project).

OBJECTIVE: The lack of standardised unit cost data is a major barrier to the quality and comparability of health economic evaluations in France. Although such evaluations are often required for reimbursement decisions, no national reference cost framework existed outside the hospital sector. The MOVIE project fills this gap by developing the first French reference unit cost framework for 22 healthcare services, using 2021 data from a representative sample of the National Health Data System.

METHODS: Total billed amounts, social health insurance reimbursements, and patient out-of-pocket payments were estimated, in line with the collective perspective recommended by French authorities. The methodology was structured into three steps and was repeated for each of the 22 healthcare services. Step 1 consisted of a comprehensive literature review. Step 2 consisted of developing and executing the data query plan using the 2021 ESND database and then defining the statistical unit. Step 3 aimed to verify the consistency of the database with official statistics, estimates derived from the 2% sample that were extrapolated to the national level and compared with annually published macro-level data from official institutions collected in Step 1.

RESULTS: In 2021, the mean consultation cost was estimated at €39.8 (SD €12.6) for General Practitioners (GPs) and €66.1 (SD €37.1) for specialist physicians. Results show wide variation in unit costs across services, with low variability for allied health care and GP visits, and high variability and strong right-skewness for services such as inpatient care, chemotherapy, and dental care. Mean consultation costs were higher than commonly used tariffs, reflecting additional fees and incentives.

CONCLUSION: Overall, this framework improves quality and comparability of economic evaluations and supports better-informed healthcare decision-making in France.