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Bohingamu Mudiyanselage S, Considine J, Hutchinson AM, Mitchell I, Mohebbi M, Watts JJ, Bucknall TK. An economic evaluation of the Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) clinical trial. Resuscitation 2024:110272. [PMID: 38866230 DOI: 10.1016/j.resuscitation.2024.110272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/26/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Early recognition and response to clinical deterioration reduce the frequency of in-hospital cardiac arrests, mortality, and unplanned intensive care unit (ICU) admissions. This study aimed to investigate the impact of the Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) intervention on hospital costs and patient length of stay (LOS). METHOD The PRONTO cluster randomised control trial was conducted to improve nurses' responses to patients with abnormal vital signs. Hospital data were collected pre-intervention (T0) at 6 months (T1) and 12 months (T2) post-intervention. The economic evaluation involved a cost-consequence analysis from the hospital's perspective. Generalised estimating equations were used to estimate the parameters for regression models of the difference in costs and LOS between study groups and time points. RESULTS Hospital admission data for 6065 patients (intervention group, 3102; control group, 2963) were collected from four hospitals for T0, T1 and T2. The intervention cost was 69.61 A$ per admitted patient, including the additional intervention training for nurses and associated labour costs. The results showed cost savings and a shorter LOS in the intervention group between T0 - T1 and T0 - T2 (cost differences T0 - T1: -364 (95% CI -3782; 3049) A$ and T0 - T2: -1710 (95% CI -5162; 1742) A$; and LOS differences T0 - T1: -1.10 (95% CI -2.44; 0.24) days and T0 & T2: -2.18 (95% CI -3.53; -0.82) days). CONCLUSION The results of the economic analysis demonstrated that the PRONTO intervention improved nurses' responses to patients with abnormal vital signs and significantly reduced hospital LOS by two days at 12 months in the intervention group compared to baseline. From the hospital's perspective, savings from reduced hospitalisations offset the costs of implementing PRONTO.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia
| | - Imogen Mitchell
- Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia; Research and Academic Partnerships, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
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2
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Wang S, Ning J, Xu Y, Shih YCT, Shen Y, Li L. Longitudinal varying coefficient single-index model with censored covariates. Biometrics 2024; 80:ujad006. [PMID: 38364803 PMCID: PMC10871868 DOI: 10.1093/biomtc/ujad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 08/26/2023] [Accepted: 10/31/2023] [Indexed: 02/18/2024]
Abstract
It is of interest to health policy research to estimate the population-averaged longitudinal medical cost trajectory from initial cancer diagnosis to death, and understand how the trajectory curve is affected by patient characteristics. This research question leads to a number of statistical challenges because the longitudinal cost data are often non-normally distributed with skewness, zero-inflation, and heteroscedasticity. The trajectory is nonlinear, and its length and shape depend on survival, which are subject to censoring. Modeling the association between multiple patient characteristics and nonlinear cost trajectory curves of varying lengths should take into consideration parsimony, flexibility, and interpretation. We propose a novel longitudinal varying coefficient single-index model. Multiple patient characteristics are summarized in a single-index, representing a patient's overall propensity for healthcare use. The effects of this index on various segments of the cost trajectory depend on both time and survival, which is flexibly modeled by a bivariate varying coefficient function. The model is estimated by generalized estimating equations with an extended marginal mean structure to accommodate censored survival time as a covariate. We established the pointwise confidence interval of the varying coefficient and a test for the covariate effect. The numerical performance was extensively studied in simulations. We applied the proposed methodology to medical cost data of prostate cancer patients from the Surveillance, Epidemiology, and End Results-Medicare-Linked Database.
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Affiliation(s)
- Shikun Wang
- Department of Biostatistics, Columbia University, NY, 10032, United States
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, TX, 77030, United States
| | - Ying Xu
- Department of Health Service Research, The University of Texas MD Anderson Cancer Center, TX, 77030, United States
| | - Ya-Chen Tina Shih
- Department of Radiation Oncology and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 90024, United States
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, TX, 77030, United States
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, TX, 77030, United States
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3
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d'Elbée M, Terris-Prestholt F, Briggs A, Griffiths UK, Larmarange J, Medley GF, Gomez GB. Estimating health care costs at scale in low- and middle-income countries: Mathematical notations and frameworks for the application of cost functions. HEALTH ECONOMICS 2023; 32:2216-2233. [PMID: 37332114 DOI: 10.1002/hec.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/13/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023]
Abstract
Appropriate costing and economic modeling are major factors for the successful scale-up of health interventions. Various cost functions are currently being used to estimate costs of health interventions at scale in low- and middle-income countries (LMICs) potentially resulting in disparate cost projections. The aim of this study is to gain understanding of current methods used and provide guidance to inform the use of cost functions that is fit for purpose. We reviewed seven databases covering the economic and global health literature to identify studies reporting a quantitative analysis of costs informing the projected scale-up of a health intervention in LMICs between 2003 and 2019. Of the 8725 articles identified, 40 met the inclusion criteria. We classified studies according to the type of cost functions applied-accounting or econometric-and described the intended use of cost projections. Based on these findings, we developed new mathematical notations and cost function frameworks for the analysis of healthcare costs at scale in LMICs setting. These notations estimate variable returns to scale in cost projection methods, which is currently ignored in most studies. The frameworks help to balance simplicity versus accuracy and increase the overall transparency in reporting of methods.
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Affiliation(s)
- Marc d'Elbée
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
- Ceped UMR 196, Université Paris Cité, Research Institute for Sustainable Development (IRD), Inserm, Paris, France
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ulla Kou Griffiths
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Health Section, Program Group, UNICEF, New York, New York, USA
| | - Joseph Larmarange
- Ceped UMR 196, Université Paris Cité, Research Institute for Sustainable Development (IRD), Inserm, Paris, France
| | - Graham Francis Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriella Beatriz Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- IAVI, New York, New York, USA
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4
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Wang S, Ning J, Xu Y, Shih YCT, Shen Y, Li L. An extension of estimating equations to model longitudinal medical cost trajectory with Medicare claims data linked to SEER cancer registry. Ann Appl Stat 2023. [DOI: 10.1214/22-aoas1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Shikun Wang
- Department of Biostatistics, Columbia University
| | - Jing Ning
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | - Ying Xu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center
| | - Yu Shen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
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5
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Zheng Y, Zhao X, Zhang X. Quantile regression for massive data with network-induced dependence, and application to the New York statewide planning and research cooperative system. COMMUN STAT-THEOR M 2022. [DOI: 10.1080/03610926.2020.1786120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yanqiao Zheng
- Department of Financial Engineering, School of Finance, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Xiaobing Zhao
- School of Data Sciences, Zhejiang University of Finance and Economics, Hangzhou, China
| | - Xiaoqi Zhang
- Department of Financial Engineering, School of Finance, Zhejiang University of Finance and Economics, Hangzhou, China
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6
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Ren J, Tapert S, Fan CC, Thompson WK. A semi-parametric Bayesian model for semi-continuous longitudinal data. Stat Med 2022; 41:2354-2374. [PMID: 35274335 DOI: 10.1002/sim.9359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 11/11/2022]
Abstract
Semi-continuous data present challenges in both model fitting and interpretation. Parametric distributions may be inappropriate for extreme long right tails of the data. Mean effects of covariates, susceptible to extreme values, may fail to capture relevant information for most of the sample. We propose a two-component semi-parametric Bayesian mixture model, with the discrete component captured by a probability mass (typically at zero) and the continuous component of the density modeled by a mixture of B-spline densities that can be flexibly fit to any data distribution. The model includes random effects of subjects to allow for application to longitudinal data. We specify prior distributions on parameters and perform model inference using a Markov chain Monte Carlo (MCMC) Gibbs-sampling algorithm programmed in R. Statistical inference can be made for multiple quantiles of the covariate effects simultaneously providing a comprehensive view. Various MCMC sampling techniques are used to facilitate convergence. We demonstrate the performance and the interpretability of the model via simulations and analyses on the National Consortium on Alcohol and Neurodevelopment in Adolescence study (NCANDA) data on alcohol binge drinking.
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Affiliation(s)
- Junting Ren
- Division of Biostatistics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA.,Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, California, USA
| | - Susan Tapert
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Chun Chieh Fan
- Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, California, USA.,Center for Human Development, University of California San Diego, La Jolla, California, USA
| | - Wesley K Thompson
- Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, California, USA.,Department of Radiology, University of California San Diego, La Jolla, California, USA
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7
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Medical Cost of Cancer Care for Privately Insured Children in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136746. [PMID: 34201571 PMCID: PMC8267683 DOI: 10.3390/ijerph18136746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/19/2021] [Indexed: 11/27/2022]
Abstract
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.
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8
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Buder I, Waitzman N, Zick C. The medical costs of low leisure-time physical activity among working-age adults: Gender and minority status matter. Prev Med 2020; 141:106273. [PMID: 33022316 DOI: 10.1016/j.ypmed.2020.106273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/13/2020] [Accepted: 09/19/2020] [Indexed: 11/17/2022]
Abstract
This study analyzes the direct medical costs of low physical activity by race/ethnicity and gender. Average health expenditures based on physical activity status for Black non-Hispanics (NH), Asian NHs, and Hispanics were compared to White NHs. Data from the National Health Interview Survey were merged with the Medical Expenditure Panel Survey for years 2000-2010 and 2001-2011, respectively, and weights were applied to ensure generalizability to the larger US population. The sample was restricted to non-pregnant adults between the ages of 25 and 64, with a final sample size of 44,953. The multivariate estimates reveal statistically significant lower annual health care expenditures among physically active men and women in five out of eight racial/ethnic groups relative to their inactive counterparts: on average, for men, $1041 less is spent among White NHs, $905 less is spent for Black NHs and $876 less is spent for Asian NHs. Among women, medical expenditures were $956 per year less among active White non-Hispanics relative to their inactive counterparts, and $815 per year among Hispanics. Essentially, the average reduction in health care expenditures is relatively consistent for five out of the eight groups. The absence of any reduction in average health care expenditures for three of the groups, however, suggests that there may be environmental factors at play for certain groups that mitigate the impact of physical activity on health expenditures.
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Affiliation(s)
- Iris Buder
- Idaho State University, Business Administration, Room 537, 921 South 8th Avenue Pocatello, ID 83209, USA.
| | - Norman Waitzman
- University of Utah, 260 Central Campus Drive, Gardner Commons, RM 4100, Salt Lake City, UT 84112, USA.
| | - Cathleen Zick
- University of Utah, 260 Central Campus Drive, Gardner Commons, RM 4100, Salt Lake City, UT 84112, USA.
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9
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Wei G, Qin G. Empirical likelihood-based inferences for median medical cost regression models with censored data. J Biopharm Stat 2020; 31:216-232. [PMID: 32951509 DOI: 10.1080/10543406.2020.1821701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent studies show that medical cost data can be heavily censored and highly skewed, which leads to have more complex cost data analysis. In this paper, we propose influence function and empirical likelihood (EL)-based methods to construct confidence regions for regression parameters in median cost regression models with censored data. We further propose confidence intervals for the median cost with given covariates using the proposed EL-based confidence regions. Simulation studies are conducted to compare the proposed EL-based confidence regions with the existing normal approximation-based confidence regions in terms of coverage probabilities. The new EL-based methods are observed to have better finite sample performances than existing methods particularly when the censoring proportion is high. The new methods are also illustrated through a real data example.
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Affiliation(s)
- Guanhao Wei
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, USA
| | - Gengsheng Qin
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, USA
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10
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Liao CT, Yang CT, Chen PH, Toh HS, Kuo S, Chen ZC, Ou HT, Ko NY, Wang JD. Association of adherence to antiretroviral therapy with economic burden of cardiovascular disease in HIV-infected population. Eur J Prev Cardiol 2020; 28:326-334. [PMID: 33891692 DOI: 10.1177/2047487320908085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/31/2020] [Indexed: 12/21/2022]
Abstract
AIMS There is a lack of studies that rigorously and systematically assess the economic burden of cardiovascular diseases (CVDs) related to the use of antiretroviral therapy (ART). We aimed to assess the association between adherence to ART and economic burden of CVDs in an HIV-infected population. METHODS Taiwan's National Health Insurance Research Database 2000-2011 was utilized for analyzing 18,071 HIV-infected patients free of CVDs before HIV diagnosis. The level of adherence to ART was measured by the medication possession ratio (MPR). Generalized estimating equations analysis was applied to estimate the cost impact of a variety of CVDs. All costs were presented in 2018 US dollars. RESULTS The incidence of CVDs ranged from 0.17/1000 person-years (cardiogenic shock) to 2.60/1000 person-years (ischemic heart diseases (IHDs)). The mean annual medical cost for a base-case patient without CVDs was US$3000. Having cerebrovascular diseases, myocardial infarction, heart failure, arrhythmia, and IHDs increased annual costs by 41%, 33%, 30%, 16%, and 14%, respectively. The cost impact of incident CVDs in years with high adherence to ART (MPR ≥ 0.8) was significantly lower than that in years with low adherence (MPR < 0.1) (e.g. having cerebrovascular diseases in the high- versus low-adherence years increased annual costs by 21% versus 259%, respectively). CONCLUSION The economic burden of incident CVDs in an HIV-infected population was compelling and varied by the extent of using ART. A reduced economic impact of CVDs was found in years when patients possessed a greater adherence to ART.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiology, Department of Internal Medicine, Chimei Medical Center, USA.,Department of Public Health, College of Medicine, National Cheng Kung University, USA
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, USA
| | - Pin-Hao Chen
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, USA
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chimei Medical Center, USA.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, USA
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, USA.,Michigan Center for Diabetes Translational Research, University of Michigan, Ann Arbor, USA
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chimei Medical Center, USA
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, USA.,Department of Pharmacy, College of Medicine, National Cheng Kung University, USA.,Department of Pharmacy, National Cheng Kung University Hospital, USA
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, USA
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, USA
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11
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Kim HJ, Roh T, Choi T. Bayesian analysis of semiparametric Bernstein polynomial regression models for data with sample selection. STATISTICS-ABINGDON 2019. [DOI: 10.1080/02331888.2019.1624964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hea-Jung Kim
- Department of Statistics, Dongguk University, Seoul, Republic of Korea
| | - Taeyoung Roh
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Taeryon Choi
- Department of Statistics, Korea University, Seoul, Republic of Korea
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12
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Liu L, Shih YCT, Strawderman RL, Zhang D, Johnson BA, Chai H. Statistical Analysis of Zero-Inflated Nonnegative Continuous Data: A Review. Stat Sci 2019. [DOI: 10.1214/18-sts681] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Zhao X, Wang W, Liu L, Shih YCT. A flexible quantile regression model for medical costs with application to Medical Expenditure Panel Survey Study. Stat Med 2018; 37:2645-2666. [PMID: 29722044 DOI: 10.1002/sim.7670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 11/11/2022]
Abstract
Medical costs are often skewed to the right and heteroscedastic, having a sophisticated relation with covariates. Mean function regression models with low-dimensional covariates have been extensively considered in the literature. However, it is important to develop a robust alternative to find the underlying relationship between medical costs and high-dimensional covariates. In this paper, we propose a new quantile regression model to analyze medical costs. We also consider variable selection, using an adaptive lasso penalized variable selection method to identify significant factors of the covariates. Simulation studies are conducted to illustrate the performance of the estimation method. We apply our method to the analysis of the Medical Expenditure Panel Survey dataset.
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Affiliation(s)
- Xiaobing Zhao
- School of Data Sciences, Zhejiang University of Finance and Economics, Hangzhou, Zhejiang, China
| | - Weiwei Wang
- School of Statistics, East China Normal University, Shanghai, China
| | - Lei Liu
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO, U.S.A
| | - Ya-Chen T Shih
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, U.S.A
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14
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Li L, Wu CH, Ning J, Huang X, Tina Shih YC, Shen Y. Semiparametric Estimation of Longitudinal Medical Cost Trajectory. J Am Stat Assoc 2018; 113:582-592. [PMID: 30853736 DOI: 10.1080/01621459.2017.1361329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Estimating the average monthly medical costs from disease diagnosis to a terminal event such as death for an incident cohort of patients is a topic of immense interest to researchers in health policy and health economics because patterns of average monthly costs over time reveal how medical costs vary across phases of care. The statistical challenges to estimating monthly medical costs longitudinally are multifold; the longitudinal cost trajectory (formed by plotting the average monthly costs from diagnosis to the terminal event) is likely to be nonlinear, with its shape depending on the time of the terminal event, which can be subject to right censoring. The goal of this paper is to tackle this statistically challenging topic by estimating the conditional mean cost at any month t given the time of the terminal event s. The longitudinal cost trajectories with different terminal event times form a bivariate surface of t and s, under the constraint t ≤ s. We propose to estimate this surface using bivariate penalized splines in an Expectation-Maximization algorithm that treats the censored terminal event times as missing data. We evaluate the proposed model and estimation method in simulations and apply the method to the medical cost data of an incident cohort of stage IV breast cancer patients from the Surveillance, Epidemiology and End Results-Medicare Linked Database.
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Affiliation(s)
- Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030
| | - Chih-Hsien Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030
| | - Xuelin Huang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030
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15
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Smith VA, Preisser JS. A marginalized two-part model with heterogeneous variance for semicontinuous data. Stat Methods Med Res 2018; 28:1412-1426. [PMID: 29451088 DOI: 10.1177/0962280218758358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Semicontinuous data, characterized by a point mass at zero followed by a positive, continuous distribution, arise frequently in medical research. These data are typically analyzed using two-part mixtures that separately model the probability of incurring a positive outcome and the distribution of positive values among those who incur them. In such a conditional specification, however, standard two-part models do not provide a marginal interpretation of covariate effects on the overall population. We have previously proposed a marginalized two-part model that yields more interpretable effect estimates by parameterizing the model in terms of the marginal mean. In the original formulation, a constant variance was assumed for the positive values. We now extend this model to a more general framework by allowing non-constant variance to be explicitly modeled as a function of covariates, and incorporate this variance into two flexible distributional assumptions, log-skew-normal and generalized gamma, both of which take the log-normal distribution as a special case. Using simulation studies, we compare the performance of each of these models with respect to bias, coverage, and efficiency. We illustrate the proposed modeling framework by evaluating the effect of a behavioral weight loss intervention on health care expenditures in the Veterans Affairs health system.
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Affiliation(s)
- Valerie A Smith
- 1 Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC, USA.,2 Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - John S Preisser
- 3 Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
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16
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Liu L, Sun Z. Kernel-based global MLE of partial linear random effects models for longitudinal data. J Nonparametr Stat 2017. [DOI: 10.1080/10485252.2017.1339308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lei Liu
- Department of Preventive Medicine and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Zhihua Sun
- School of Mathematical Sciences, University of Chinese Academy of Sciences, Beijing, People's Republic of China
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