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A comparison of statistical methods for allocating disease costs in the presence of interactions
Statistics in Medicine ( IF 1.8 ) Pub Date : 2021-04-11 , DOI: 10.1002/sim.8950
Jean-Benoît Rossel 1 , Valentin Rousson 1 , Yves Eggli 1
Affiliation  

We consider the non-trivial problem of estimating a health cost repartition among diseases from patients' hospital stays' global costs in the presence of multimorbidity, that is, when the patients may suffer from more than one disease. The problem is even harder in the presence of interactions among the disease costs, that is, when the costs of having, for example, two diseases simultaneously do not match the sum of the basic costs of having each disease alone, generating an extra cost which might be either positive or negative. In such a situation, there might be no “true solution” and the choice of the method to be used to solve the problem will depend on how one wishes to allocate the extra costs among the diseases. In this article, we study mathematically how different methods proceed in this regard, namely ordinary least squares (OLS), generalized linear models (GLM), and an iterative proportional repartition (IPR) algorithm, in a simple case with only two diseases. It turned out that only IPR allowed to retrieve the total costs and the unambiguous solution that one would have in a setting without interaction, that is, when no extra cost has to be allocated, while OLS and GLM may produce some negative health costs. Also, contrary to OLS, IPR is taking into account the basic costs of the diseases for the allocation of the extra cost. We conclude that IPR seems to be the most natural method to solve the problem, at least among those considered.

中文翻译:

存在相互作用时分配疾病成本的统计方法的比较

我们考虑在存在多种疾病的情况下(即,当患者可能患有不止一种疾病时)根据患者住院时间的全球成本估算疾病之间健康成本再分配的重要问题。如果疾病成本之间存在相互作用,这个问题就更难了,也就是说,当同时患有两种疾病的成本与单独患有每种疾病的基本成本之和不匹配时,会产生额外的成本可能是积极的,也可能是消极的。在这种情况下,可能没有“真正的解决方案”,选择用于解决问题的方法将取决于人们希望如何在疾病之间分配额外成本。在本文中,我们从数学上研究了在这方面如何进行不同的方法,即普通最小二乘法 (OLS),广义线性模型 (GLM) 和迭代比例重新分配 (IPR) 算法,在只有两种疾病的简单情况下。结果证明,只有 IPR 允许检索总成本和一个人在没有交互的环境中将拥有的明确解决方案,即无需分配额外成本时,而 OLS 和 GLM 可能会产生一些负面的健康成本。此外,与OLS相反,IPR正在考虑疾病的基本成本来分配额外成本。我们得出的结论是,知识产权似乎是解决问题的最自然的方法,至少在所考虑的方法中是这样。结果证明,只有 IPR 允许检索总成本和一个人在没有交互的环境中将拥有的明确解决方案,即无需分配额外成本时,而 OLS 和 GLM 可能会产生一些负面的健康成本。此外,与OLS相反,IPR正在考虑疾病的基本成本来分配额外成本。我们得出的结论是,知识产权似乎是解决问题的最自然的方法,至少在所考虑的方法中是这样。结果证明,只有 IPR 允许检索总成本和一个人在没有交互的环境中将拥有的明确解决方案,即无需分配额外成本时,而 OLS 和 GLM 可能会产生一些负面的健康成本。此外,与OLS相反,IPR正在考虑疾病的基本成本来分配额外成本。我们得出的结论是,知识产权似乎是解决问题的最自然的方法,至少在所考虑的方法中是这样。
更新日期:2021-06-04
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