DEVELOPING ECONOMETRIC MODELS TO ESTIMATE AIDS COSTS

开发经济模型来估算艾滋病成本

• 批准号: 2236364
• 负责人: ANTHONY LANCASTER
• 金额: $ 19.54万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-04-01 至 1996-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2236364
• 关键词: AIDS; health care cost /financing; health care service utilization; health surveys; human data; human immunodeficiency virus; human morbidity; human mortality; mathematical model; model design /development

The AIDS epidemic continues to grow at an alarming rate, particularly among the poor and drug injecting population. The advent of effective anti-viral therapies ad earlier identification of HIV infected individuals is projected to increase the health care costs of AIDS. Estimating the demand for hospitalization and health care in general in the combing decades is complicated by this "moving target". Current approaches to estimating the health care costs of the epidemic have used a "spreadsheet", or actuarial, approach which ignores the substantial heterogeneity in the demand for medical care. Estimating demand from cross-sectional data is limited by our ability to control proximity to death since costs in the last months of life are known to differ substantially from earlier patterns. On the other hand, panel data analysis is complicated by non-random attrition (mortality) with respect to health, ad therefore with respect to the demand for health care. To estimate a lifetime demand for care requires a model which both predicts survival medical usage. We propose to develop an econometric framework for the simultaneous study of health care usage and survival in which there is an interpretable separation of the demand for care and the process of mortality. At the heart of the framework is a probabilities model for the evolution of patients' health, viewed as a latent, or unobserved, variable whose level affects both the demand for care and survival risk. Health is determined in a sequence of random draws from a probability distribution which itself may be changing over time due to the evolution of exogenous time- varying covariates and earlier medical treatment. Mortality arises when the health care use is triggered by a second threshold whose person specific value will depend upon the standard economic variables normally used in cross-sectional demand analyses. This model will be further developed and the necessary computer software written initially using a AHCPR funded cohort of AIDS patients non- randomly selected from participants in a service program. The model will be refined using the AHCPR funded AIDS Cost and Service Utilization Survey (ACSUS) which includes over 2000 HIV infected persons from hospital based clinics with early and late stage disease who were followed for 18 months. Emerging from this model development and application process will be a series of synthetic estimates of the per- person lifetime costs of HIV disease for various groups of infected individuals.

艾滋病继续以惊人的速度蔓延，特别是 在穷人和注射毒品的人群中。 有效的到来 抗病毒治疗和早期识别HIV感染者 个人预计将增加艾滋病的医疗保健费用。 估计2001 - 2005年一般住院和保健需求 这种“移动的目标”使几十年的梳理变得复杂。 目前估计艾滋病保健费用的方法 我使用了一种“电子表格”或精算方法，这种方法忽略了 医疗需求的巨大差异。 估计 对横截面数据的需求受到我们控制能力的限制 接近死亡，因为已知生命最后几个月的费用 与以前的模式大不相同。 另一方面， 非随机损耗（死亡率）使数据分析复杂化， 因此，在健康需求方面， 在乎 要估计一生的护理需求，需要一个模型， 预测生存医学用途。 我们建议发展一个计量经济学框架， 医疗保健的使用和生存，其中有一个解释， 将护理需求和死亡过程分开。 在 该框架的核心是一个概率模型的演变， 病人的健康，被视为一个潜在的，或未观察到的变量，其水平 影响护理需求和生存风险。 健康状况取决 在从概率分布中随机抽取的序列中， 它本身可能由于外生时间的演化而随时间变化- 不同的协变量和早期治疗。 死亡率出现在 所述健康护理使用由第二阈值触发， 具体价值通常取决于标准经济变量 用于横截面需求分析。 这一模式将进一步发展和必要的计算机软件 最初使用AHCPR资助的艾滋病患者队列撰写， 从服务项目的参与者中随机挑选。 该模型将 利用AHCPR资助的艾滋病成本和服务利用率 调查（ACSUS），其中包括2000多名艾滋病毒感染者， 早期和晚期疾病的医院诊所， 追踪了18个月。 从这种模式的发展和 申请过程将是一系列的综合估计每- 各感染群体的艾滋病毒疾病终生费用 个体