Regression models for analyzing costs and their determinants in health care: an introductory review

Gregori, Darío; Petrinco, Michele; Bo, Simona; Desideri, Alessandro; Merletti, Franco; Pagano, Eva

doi:10.1093/intqhc/mzr010

Cited by 142 publications

(113 citation statements)

References 78 publications

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“…As a large proportion of patients incurred no relevant hospitalization costs and the costs conditional to (c i >0) displayed a skewed distribution, a 2-part model was used to model separately (1) the probability by guest on May 13, 2018 http://stroke.ahajournals.org/ Downloaded from of incurring any hospitalization costs and (2) the level of costs of those with positive costs. 17,18 The conditional expectation of the cost was divided into 2 parts:…”

Section: Discussionmentioning

confidence: 99%

“…The second part was used to analyze the level of total costs for patients who were hospitalized and was constructed via a generalized linear model with a γ-distribution and identity link function. 18 The 2 parts of the model were combined to estimate the marginal effect of therapy resumption on the predicted, mean, discounted, 3-year hospitalization cost per patient as given by the partial derivatives of the marginal expectation 17,18 :…”

Section: Discussionmentioning

confidence: 99%

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Effect of Anticoagulation on Hospitalization Costs After Intracranial Hemorrhage in Atrial Fibrillation

Vestergaard

Skjøth

Lip³

et al. 2016

Stroke

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Background and Purpose-Intracranial hemorrhage (ICH) is the most feared adverse event with oral anticoagulant therapy in patients with atrial fibrillation. The health economic aspects of resuming oral anticoagulant therapy after ICH are unknown. The aim was to estimate hospitalization costs of thromboembolism and hemorrhage subsequent to ICH in 2 patient groups with atrial fibrillation surviving the first 90 days post ICH: (1) patients resuming warfarin therapy within 90 days post ICH and (2) patients discontinuing therapy. Methods-Retrospective data from Danish national registries were linked to identify patients with atrial fibrillation who suffered an ICH between January 1, 1997, and April 1, 2011. Study start was 90 days after incident ICH. Mortality was evaluated using the Kaplan-Meier estimate. Occurrence of hospitalization-requiring thromboembolism and hemorrhage was used to estimate hospitalization costs by linkage of International Classification of Diseases, Tenth Revision, codes to Danish Diagnosis-Related Group tariffs. The effect of resuming warfarin therapy on average 3-year hospitalization costs was estimated by regression analysis adjusted for between-group differences in baseline characteristics. Results-In the inclusion period, 2162 patients had an ICH; 1098 survived the first 90 days and were included for analysis, and of those, 267 resumed warfarin therapy. Therapy resumption reduced the mean 3-year hospitalization cost of hospitalized patients significantly by US$ 1588 (95% confidence interval, −2925 to −251) and was significantly correlated with fewer hospitalization days per hospitalized patient (−4.6 [95% confidence interval, −7.6 to −1.6]). The marginal effect of therapy resumption on hospitalization costs per patient was US$ −407 (95% confidence interval, −815 to 2). Conclusions-Resuming warfarin therapy within 90 days after ICH in patients with atrial fibrillation is associated with a decrease in average hospitalization costs. (Stroke. 2016;47:979-985.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Anticoagulation on Hospitalization Costs After Intracranial Hemorrhage in Atrial Fibrillation

Vestergaard

Skjøth

Lip³

et al. 2016

Stroke

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“…The separate associations of baseline depressive symptom severity, anxiety symptom severity and functioning with costs at the 6-month follow-up were determined using unadjusted and adjusted exponentiated coefficients [with 95% confidence intervals (CIs)] modelled through ‘GLM-log-gamma’ analysis, which accounted for the skewness in the costs outcome. The skewness can be illustrated by the presence of markedly higher mean costs (£3899) than median costs (£1595); GLM-log-gamma is widely considered the analysis of choice for predicting skewed costs outcomes (with few zero values), largely because it shares the benefits of log or Box–Cox transformation while facilitating ease of interpretation of coefficients and avoiding back-transformation issues (Gregori et al , 2011). The exponentiated coefficients indicated the percentage increase in the mean costs per unit increase in the specified covariate.…”

Section: Participants and Methodsmentioning

confidence: 99%

Utility of functioning in predicting costs of care for patients with mood and anxiety disorders

Twomey¹,

Cieza

Baldwin

2017

International Clinical Psychopharmacology

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Development of payment systems for mental health services has been hindered by limited evidence for the utility of diagnosis or symptoms in predicting costs of care. We investigated the utility of functioning information in predicting costs for patients with mood and anxiety disorders. This was a prospective cohort study involving 102 adult patients attending a tertiary referral specialist clinic for mood and anxiety disorders. The main outcome was total costs, calculated by applying unit costs to healthcare use data. After adjusting for covariates, a significant total costs association was yielded for functioning (eβ=1.02; 95% confidence interval: 1.01–1.03), but not depressive symptom severity or anxiety symptom severity. When we accounted for the correlations between the main independent variables by constructing an abridged functioning metric, a significant total costs association was again yielded for functioning (eβ=1.04; 95% confidence interval: 1.01–1.09), but not symptom severity. The utility of functioning in predicting costs for patients with mood and anxiety disorders was supported. Functioning information could be useful within mental health payment systems.

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“…These cost and utility data have been mapped to the specified model states in a previous publication [13] by fitting three generalised linear regression models (GLMs) assuming a gamma distribution with a log link as recommended in the literature for skewed, non-censored, non-zero inflated data [22]. The main explanatory variables were dummy variables for ambulatory class in the first GLM, a continuous variable for total DMDSAT score in the second GLM and dummy variables for ventilation status in the third GLM.…”

Section: Methodsmentioning

confidence: 99%

Economic Evaluation in Duchenne Muscular Dystrophy: Model Frameworks for Cost-Effectiveness Analysis

et al. 2016

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BackgroundSeveral treatments are on the horizon for Duchenne muscular dystrophy (DMD), a terminal orphan disease. In many jurisdictions, decisions regarding pricing and reimbursement of these health technologies comprise evidence of value for money.ObjectiveThe objective of this study was to develop a cost-effectiveness model based on the Duchenne muscular dystrophy Functional Ability Self-Assessment Tool (DMDSAT), a new rating scale created specifically to measure disease progression in clinical practice and trials and model DMD in economic evaluations, and compare it with two alternative model structures.MethodsWe constructed three Markov cohort state-transition models to evaluate the cost-effectiveness of a hypothetical intervention for DMD versus standard of care in a UK setting. Model I was based on the DMDSAT, model II on stages of disease as defined in the DMD clinical care guidelines and model III on patients’ ventilation status. The conceptual model structures were formulated in collaboration with three DMD experts.ResultsAll three models were judged to have good validity with regards to the appropriateness of the choice of modelling technique, conceptual representation of the disease, model input data and model outcomes. Across frameworks, lifetime direct medical costs with standard of care ranged between £217,510 and £284,640, total costs between £624,240 and £713,840, and total number of quality-adjusted life-years between 5.96 and 7.17.ConclusionsWe present a first version of a model for the economic evaluation of treatments for DMD based on the DMDSAT, as well as two alternative frameworks encompassing conventional staging of disease progression. Our findings should be helpful to inform health technology assessments and health economic programmes of future treatments for DMD.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0461-5) contains supplementary material, which is available to authorized users.

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Regression models for analyzing costs and their determinants in health care: an introductory review

Abstract: The matching of healthcare cost models to the analytic objectives and characteristics of the data available to a study requires caution. The study results and interpretation can be heavily dependent on the choice of model with a real risk of spurious results and conclusions.

Cited by 142 publications

References 78 publications

Effect of Anticoagulation on Hospitalization Costs After Intracranial Hemorrhage in Atrial Fibrillation

Effect of Anticoagulation on Hospitalization Costs After Intracranial Hemorrhage in Atrial Fibrillation

Utility of functioning in predicting costs of care for patients with mood and anxiety disorders

Economic Evaluation in Duchenne Muscular Dystrophy: Model Frameworks for Cost-Effectiveness Analysis

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