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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Grieve, Richard David
Languages: English
Types: Doctoral thesis

Classified by OpenAIRE into

mesheuropmc: health care economics and organizations
This thesis is concerned with the estimation \ud of costs \ud in \ud economic evaluation. \ud The \ud thesis reviews the theoretical and applied \ud literature \ud on costing \ud and \ud highlights that \ud studies generally ignore cost variation \ud across \ud health \ud care settings. \ud The thesis \ud aims \ud to \ud assess why costs vary across health care \ud settings, \ud and the implications for \ud economic \ud evaluations. \ud The study uses microeconomic theory to \ud pose \ud hypotheses for \ud cost \ud variation across \ud health care settings and uses a consistent methodology to \ud collect costs across \ud a range \ud of health care settings. The analysis \ud uses \ud multilevel \ud models \ud (MLMs) to test \ud hypotheses concerning cost variation. \ud Statistical theory \ud suggests that \ud MLMs \ud accommodate the hierarchical structure of \ud the \ud data \ud and \ud may \ud therefore \ud be \ud more \ud appropriate than ordinary least squares \ud (OLS) \ud models \ud for identifying \ud reasons \ud for \ud cost \ud variation across settings. The use of MLMs and \ud OLS \ud models \ud for \ud analysing reasons \ud for \ud cost variation are compared. The OLS models \ud find that \ud both \ud patient \ud and \ud higher-level \ud covariates are associated with length of \ud hospital \ud stay \ud (LOS) \ud and total \ud cost, \ud but these \ud models overestimate the precision of the \ud higher-level \ud variables. \ud By \ud contrast, \ud the \ud MLMs show that none of the higher-level variables are \ud associated \ud with \ud LOS, \ud and \ud the \ud national level of spending on health care \ud is the \ud only \ud higher-level \ud variable associated \ud with total cost. \ud The empirical investigation also illustrates that \ud using \ud OLS \ud regression \ud analysis \ud to \ud report cost-effectiveness can lead to inaccurate \ud estimates. \ud By \ud contrast, \ud the \ud MLMs \ud recognise the structure of the data and accurately \ud quantify \ud mean \ud incremental \ud cost- \ud effectiveness and the associated levels of \ud uncertainty. \ud The thesis concludes that ignoring cost \ud variation \ud across \ud health \ud care \ud settings \ud can \ud lead \ud to inaccurate estimates of cost and \ud cost-effectiveness. \ud Basing \ud decision-making \ud on \ud inaccurate information can move the allocation \ud of \ud health \ud care \ud resources \ud away \ud from the \ud target of allocative efficiency. This thesis presents \ud a methodology \ud for improving the \ud conduct of cost analyses that future economic evaluations can \ud adopt.
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    • Health Econ.14: 185-196(2005)
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