USING COST‐EFFECTIVENESS ESTIMATES FROM SURVEY DATA TO GUIDE COMMISSIONING: AN APPLICATION TO HOME CARE. (27th August 2013)

• Record Type: Journal Article
• Authors: Forder, Julien; Malley, Juliette; Towers, Ann‐Marie; Netten, Ann
• Is Part Of: Health economics. Volume 23:Number 8(2014:Aug.)
• Page Start: 979
• Page End: 992
• Publication Date: 2013-08-27
• Subjects: Medical economics -- Periodicals; Economics, Medical -- Periodicals; Health Care Costs -- Periodicals; Health Policy -- economics -- Periodicals; Health Services -- economics -- Periodicals; 362.1
• DOI: 10.1002/hec.2973
• Languages: English
• ISSNs: 1057-9230

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <p>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.</p> <p>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.</p> <p>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 © 2013 John Wiley &amp; Sons, Ltd.</p> </abstract>