Cost Data

Costs in Synthea represent a very simplified version of real-world costs. While real-world costs can vary wildly due to differences in providers, cities, states, and payers -- as of May 2018 -- Synthea only models cost at a basic level, where prices for a service are selected from a range and then adjusted using a state-based adjustment factor. Synthea stores all these prices in lookup tables as listed below.

In the case where costs are not included in the lookup tables, there are default values configured in the src/main/resources/synthea.properties file:

# Default Costs, to be used for pricing something that we don't have a specific price for
# -- $500 for procedures is completely invented
generate.costs.default_procedure_cost = 500.00
# -- $255 for medications - also invented
generate.costs.default_medication_cost = 255.00
# -- Encounters billed using avg prices from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096340/
# -- Adjustments for initial or subsequent hospital visit and level/complexity/time of encounter
# -- not included. Assume initial, low complexity encounter (Tables 4 & 6)
generate.costs.default_encounter_cost = 125.00
# -- https://www.nytimes.com/2014/07/03/health/Vaccine-Costs-Soaring-Paying-Till-It-Hurts.html
# -- currently all vaccines cost $136.
generate.costs.default_immunization_cost = 136.00

Encounters

Encounter costs are stored in src/main/resources/costs/encounters.csv.

Format:

Code	Min	Mode	Max	Comments
The SNOMED code for the encounter	The minimum cost, in USD.	The most common cost, in USD.	The maximum cost, in USD.	Any comments on how the cost was determined. This is only intended to be read by maintainers and not parsed by the system

Procedures

Procedure costs are stored in src/main/resources/costs/procedures.csv.

Code	Min	Mode	Max	Comments
The SNOMED code for the procedure	The minimum cost, in USD.	The most common cost, in USD.	The maximum cost, in USD.	Any comments on how the cost was determined. This is only intended to be read by maintainers and not parsed by the system

Where not otherwise mentioned, procedure costs are likely based on publicly available Medicare data: https://hcupnet.ahrq.gov/#query/eyJBTkFMWVNJU19UWVBFIjpbIkFUX1EiXSwiWUVBUlMiOlsiWVJfMjAxNCJdLCJTVEFURVMiOlsiU1RfTUEiXSwiQ0FURUdPUklaQVRJT05fVFlQRSI6WyJDVF9DQ1NQIl0sIlFVSUNLVEFCTEVfVFlQRSI6WyJRVFRfREVUIl0sIkRBVEFTRVRfU09VUkNFIjpbIkRTX1NJRCJdfQ==

Medications

Medication costs are stored in src/main/resources/costs/medications.csv.

Code	Min	Mode	Max	Comments
The RxNorm code for the medication	The minimum cost, in USD.	The most common cost, in USD.	The maximum cost, in USD.	Any comments on how the cost was determined. This is only intended to be read by maintainers and not parsed by the system

Where not specifically mentioned in the comments, cost data for medications is likely to have been sourced from publicly available Medicare data: https://data.cms.gov/Medicare-Part-D/Medicare-Provider-Utilization-and-Payment-Data-201/yvpj-pmj2 For example, this data source provides medication costs grouped by drug name and provider NPI. By grouping by drug name, dividing the total_drug_cost column by the total_claim_count column, and then averaging across providers, we obtain a rough estimate of the unit cost of that drug.

Immunizations

Immunization costs are stored in src/main/resources/costs/immunizations.csv.

Code	Min	Mode	Max	Comments
The CVX code for the immunization	The minimum cost, in USD.	The most common cost, in USD.	The maximum cost, in USD.	Any comments on how the cost was determined. This is only intended to be read by maintainers and not parsed by the system

Regional Adjustment Factors

Adjustment factors are stored in src/main/resources/costs/adjustmentFactors.csv

State	Adj_Factor
The abbreviation of the state for which the factor applies	The amount to multiply costs taking place in this state by

The initial values provided in this table are not intended to be comprehensive or authoritative. These were calculated using CMS urban and rural GAFs for 2011, weighted by the % of the population living in urban in rural areas by that state.