USING COST-EFFECTIVENESS ESTIMATES FROM SURVEY DATA TO GUIDE COMMISSIONING: AN APPLICATION TO HOME CARE
USING COST-EFFECTIVENESS ESTIMATES FROM SURVEY DATA TO GUIDE COMMISSIONING: AN APPLICATION TO HOME CARE
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DOI：
10.1002/hec.2973
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发表时间：
2014-08-01
期刊：
影响因子：
2.1
通讯作者：
Netten, Ann
中科院分区：
文献类型：
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作者：
Forder, Julien;Malley, Juliette;Netten, Ann
其目的是描述和试验一个务实的方法，以产生估计的增量成本效益的护理服务的调查数据。主要的挑战是估计反事实;也就是说，如果病人没有得到这种水平的服务，他们的生活质量会如何。一个生产函数方法，旨在区分护理相关的生活质量的数据，是由于服务使用，而不是其他因素的变化。一个问题是，相关的需求因素也会影响所使用的服务量，因此，任何缺失的因素都可能造成内生偏见。工具变量估计可以缓解这个问题。这种方法被应用到老年人使用家庭护理的概念验证的调查。在分析中，我们能够使用具有预期形式和稳健估计诊断的调查数据来估计生活质量生产函数。这种方法的实际优势是显而易见的，但也存在局限性。这是计算复杂，有错误的规定和有偏见的结果，特别是与IV估计的风险。一种战略是使用这种方法提出初步估计数，如有必要，随后进行全面审判。版权所有（C）2013约翰威利父子有限公司
The aim is to describe and trial a pragmatic method to produce estimates of the incremental cost-effectiveness of care services from survey data. The main challenge is in estimating the counterfactual; that is, what the patient's quality of life would be if they did not receive that level of service. A production function method is presented, which seeks to distinguish the variation in care-related quality of life in the data that is due to service use as opposed to other factors. A problem is that relevant need factors also affect the amount of service used and therefore any missing factors could create endogeneity bias. Instrumental variable estimation can mitigate this problem.This method was applied to a survey of older people using home care as a proof of concept. In the analysis, we were able to estimate a quality-of-life production function using survey data with the expected form and robust estimation diagnostics.The practical advantages with this method are clear, but there are limitations. It is computationally complex, and there is a risk of misspecification and biased results, particularly with IV estimation. One strategy would be to use this method to produce preliminary estimates, with a full trial conducted thereafter, if indicated. Copyright (C) 2013 John Wiley & Sons, Ltd.