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Assessing the cost implications of combined pharmacotherapy in the long term management of asthma: Theory and application of methods to control selection bias.

机译：在哮喘的长期治疗中评估联合药物治疗的成本影响：控制选择偏倚的理论和方法的应用。

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摘要

We studied the cost implications of putting moderate or severe adult asthma patients, who just had asthma related hospitalization or emergency care, on combined long-term-control drug therapy (inhaled corticosteroids + long-term-control bronchodilators) versus on inhaled corticosteroids alone. The study sample was retrospectively selected from Medi-Cal eligibles between Jan. 1995--Dec. 2000. The final data set included 1,547 patients.; After adjusting the observed variables, we found no difference in one-year total health care costs between the combined therapy and the monotherapy. However, when the unobserved selectivity was also adjusted, the combined therapy was less expensive in both the treated population and the general population. The marginal savings for combined therapy would be {dollar}3150 annually. This result indicates a positive selection process (i.e. the combined therapy was given to patients whose health status could be improved the most by it).; Parametric switching regression models have been criticized for sensitivity to the normality assumption of error terms. Our Monte Carlo simulation results showed that with a strong instrument, the switching regression model was rather robust. This result justifies the use of parametric switching regression model to estimate treatment effects with a strong instrument.; Conditional expectation methods have been widely used for their simplicity, and often without adequate justification. We studied the performance of two representative conditional expectation methods. Our results showed that, a consistent estimate of treatment effect on the treated (TT) could be achieved under conditions less strict than those required to achieve a consistent estimate of average treatment effect (ATE ). When such conditions are not met, the bias of TT estimates from conditional expectation methods is correlated only with the unobserved selectivity between the treatment decision and the outcome of the control program.
机译：我们研究了将刚与哮喘相关的住院或急诊治疗的中度或重度成年哮喘患者与联合长期控制药物治疗（吸入皮质类固醇+长期控制支气管扩张药）相比单独吸入皮质类固醇的费用影响。该研究样本是从1995年1月至12月的Medi-Cal合格者中回顾性选择的。 2000年。最终数据集包括1547名患者。调整观察变量后，我们发现联合疗法和单一疗法之间一年的总医疗保健费用没有差异。但是，如果还调整了未观察到的选择性，则在接受治疗的人群和普通人群中，联合治疗的费用都较低。每年联合疗法的边际节省为3150美元。该结果表明选择过程是积极的（即，将联合疗法用于可以通过这种方式最大程度改善健康状况的患者）。有人批评参数转换回归模型对误差项的正态性假设的敏感性。我们的蒙特卡洛模拟结果表明，使用强大的仪器，切换回归模型相当强大。该结果证明使用参数转换回归模型来评估功能强大的仪器的治疗效果是合理的。有条件的期望方法由于其简单性而被广泛使用，并且通常没有足够的理由。我们研究了两种代表性条件期望方法的性能。我们的结果表明，在比获得对平均治疗效果（ATE）的一致估计所需的条件更不严格的条件下，可以实现对被治疗者（TT）的治疗效果的一致估计。当不满足这些条件时，来自条件期望方法的TT估计偏差仅与治疗决策和控制程序结果之间未观察到的选择性相关。

著录项

  • 作者

    Wu, Eric Qiong.;

  • 作者单位

    University of Southern California.;

  • 授予单位 University of Southern California.;
  • 学科 Health Sciences Health Care Management.; Economics Theory.
  • 学位 Ph.D.
  • 年度 2003
  • 页码 132 p.
  • 总页数 132
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;经济学;
  • 关键词

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