Regression analysis of incomplete medical cost data
Regression analysis of incomplete medical cost data
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DOI：
10.1002/sim.1377
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发表时间：
2003-04-15
影响因子：
2
通讯作者：
Lin, DY
中科院分区：
文献类型：
--
作者：
Lin, DY
随着时间的推移，每个受试者的医疗费用积累是一个递增的随机过程，定义为直到死亡的瞬间。这一过程的随机结构是复杂的。在大多数应用中，只能在有限的时间点观察到该过程。此外，这一过程受到正确的审查，因此在审查时间过后，它是不可观察的。医疗费用数据的这些特点，特别是死亡和审查的存在，对构建可信的统计模型和开发相应的推断程序构成了重大挑战。在这篇文章中，我们提出了几类回归模型，它们描述了可能的时间依赖协变量对死亡情况下成本积累的边际平均值或特定生存模式下的成本积累的条件均值的影响。然后，我们将纵向数据的广义估计方程方法与截尾加权的逆概率方法相结合，建立了这些模型的估计方程。对于简单的方差估计，得到的估计量是一致的，并且是渐近正态的。仿真研究表明，所提出的推理过程在实际情况下表现良好。对一项大型癌症研究数据的应用表明，被诊断患有不太严重的卵巢癌的联邦医疗保险参与者往往比那些患有更严重疾病的人累积医疗费用的比率更低，但由于他们的寿命更长，他们往往有更高的终生成本。版权所有(C)2003 John Wiley Sons，Ltd.
The accumulation of medical cost over time for each subject is an increasing stochastic process defined up to the instant of death. The stochastic structure of this process is complex. In most applications, the process can only be observed at a limited number of time points. Furthermore, the process is subject to right censoring so that it is unobservable after the censoring time. These special features of the medical cost data, especially the presence of death and censoring, pose major challenges in the construction of plausible statistical models and the development of the corresponding inference procedures. In this paper, we propose several classes of regression models which formulate the effects of possibly time-dependent covariates on the marginal mean of cost accumulation in the presence of death or on the conditional means of cost accumulation given specific survival patterns. We then develop estimating equations for these models by combining the approach of generalized estimating equations for longitudinal data with the inverse probability of censoring weighting technique. The resultant estimators are shown to be consistent and asymptotically normal with simple variance estimators. Simulation studies indicate that the proposed inference procedures behave well in practical situations. An application to data taken from a large cancer study reveals that the Medicare enrollees who are diagnosed with less aggressive ovarian cancer tend to accumulate medical cost at lower rates than those with more aggressive disease, but tend to have higher lifetime costs because they live longer. Copyright (C) 2003 John Wiley Sons, Ltd.