Tweedie distributions for fitting semicontinuous health care utilization cost data.

Tweedie distributions for fitting semicontinuous health care utilization cost data.
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DOI:
10.1186/s12874-017-0445-y
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发表时间:
2017-12-19
影响因子:
4
通讯作者:
Kurz CF
Kurz CF
中科院分区:
医学3区
文献类型:
--
作者:
Kurz CF

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医疗保健成本数据的统计分析通常存在问题,因为这些数据通常是非负的、右偏的,并且对于非用户来说有多余的零。这阻止了基于高斯或伽玛分布的线性模型的使用。解决这个问题的常见方法是使用两部分模型或 Tobit 模型,这使得结果的解释更加困难。在这项研究中,我探索了 Tweedie 分布族中的统计分布,它可以同时对零结果的概率进行建模,即成为医疗保健利用的非用户和用户的连续成本。我评估了 Tweedie 模型在蒙特卡罗模拟研究中的有用性,该研究解决了医疗保健利用的用户和非用户的低相关性和高相关性的两种常见情况。此外,我使用兰德健康保险实验的真实数据集将 Tweedie 模型与其他几个模型进行了比较。我证明了 Tweedie 分布非常适合成本数据,并且提供了更好的拟合效果,特别是当非用户数量较低且用户与非用户之间的相关性较高时。 Tweedie 分布为健康经济分析中的许多统计问题提供了一个有趣的解决方案。
The statistical analysis of health care cost data is often problematic because these data are usually non-negative, right-skewed and have excess zeros for non-users. This prevents the use of linear models based on the Gaussian or Gamma distribution. A common way to counter this is the use of Two-part or Tobit models, which makes interpretation of the results more difficult. In this study, I explore a statistical distribution from the Tweedie family of distributions that can simultaneously model the probability of zero outcome, i.e. of being a non-user of health care utilization and continuous costs for users. I assess the usefulness of the Tweedie model in a Monte Carlo simulation study that addresses two common situations of low and high correlation of the users and the non-users of health care utilization. Furthermore, I compare the Tweedie model with several other models using a real data set from the RAND health insurance experiment. I show that the Tweedie distribution fits cost data very well and provides better fit, especially when the number of non-users is low and the correlation between users and non-users is high. The Tweedie distribution provides an interesting solution to many statistical problems in health economic analyses.
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