title: Cost-of-illness studies based on massive data: a prevalence-based, top-down regression approach.
abstract: Despite the increasing availability of routine data, no analysis method has yet been presented for cost-of-illness (COI) studies based on massive data. We aim, first, to present such a method and, second, to assess the relevance of the associated gain in numerical efficiency. We propose a prevalence-based, top-down regression approach consisting of five steps: aggregating the data; fitting a generalized additive model (GAM); predicting costs via the fitted GAM; comparing predicted costs between prevalent and non-prevalent subjects; and quantifying the stochastic uncertainty via error propagation. To demonstrate the method, it was applied to aggregated data in the context of chronic lung disease to German sickness funds data (from 1999), covering over 7.3 million insured. To assess the gain in numerical efficiency, the computational time of the innovative approach has been compared with corresponding GAMs applied to simulated individual-level data. Furthermore, the probability of model failure was modeled via logistic regression. Applying the innovative method was reasonably fast (19 min). In contrast, regarding patient-level data, computational time increased disproportionately by sample size. Furthermore, using patient-level data was accompanied by a substantial risk of model failure (about 80 % for 6 million subjects). The gain in computational efficiency of the innovative COI method seems to be of practical relevance. Furthermore, it may yield more precise cost estimates.
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. bjoern.stollenwerk@helmholtz-muenchen.de.
authors: Björn
authors: B
authors: Stollenwerk
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.|Institut für Medizinische Biometrie, Informatik und Epidemiologie (IMBIE), Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany.
authors: Thomas
authors: T
authors: Welchowski
authors: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
authors: Matthias
authors: M
authors: Vogl
authors: Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany.
authors: Stephanie
authors: S
authors: Stock
mesh_terms: D017281:Cost of Illness; D003625:Data Collection; D005858:Germany; D006801:Humans; D016015:Logistic Models; D018803:Models, Economic; D015233:Models, Statistical; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics
keywords: Cost-of-illness; Error propagation; Generalized additive models; Massive data
references: Scand J Public Health. 2003;31(2):119-25
references: 12745762
references: JAMA. 2013 Apr 3;309(13):1351-2
references: 23549579
references: Med Decis Making. 2009 Sep-Oct;29(5):619-33
references: 19773581
references: Respir Med. 2011 Mar;105(3):485-93
references: 21030232
references: Milbank Mem Fund Q Health Soc. 1982 Summer;60(3):429-62
references: 6923138
references: J Health Econ. 2001 Jul;20(4):461-94
references: 11469231
references: N Engl J Med. 2014 Jun 5;370(23):2161-3
references: 24897079
references: Respir Med. 2007 Nov;101(11):2312-20
references: 17681461
references: Seizure. 2005 Jan;14(1):46-51
references: 15642500
references: Pharmacoeconomics. 2001;19 Suppl 2:1-6
references: 11700783
references: Health Econ. 2000 Jul;9(5):397-409
references: 10903540
references: Health Econ. 2011 Aug;20(8):897-916
references: 20799344
references: J Womens Health (Larchmt). 2008 Apr;17(3):343-54
references: 18338965
references: J Health Econ. 2005 May;24(3):465-88
references: 15811539
references: Eur Respir J. 2005 Jan;25(1):47-53
references: 15640322
references: BMJ. 2000 May 13;320(7245):1335
references: 10807635
references: Lancet. 2007 Sep 1;370(9589):741-50
references: 17765523
references: Can Respir J. 1998 Nov-Dec;5(6):463-71
references: 10070174
references: PLoS One. 2012;7(12):e51312
references: 23251495
references: Emerg Infect Dis. 2003 Feb;9(2):196-203
references: 12603990
references: Health Policy. 1998 Mar;43(3):243-51
references: 10178574
references: Biostatistics. 2005 Jan;6(1):93-109
references: 15618530
references: Eur J Vasc Endovasc Surg. 2012 Nov;44(5):505-13
references: 22995752
references: Am J Hum Genet. 2009 Feb;84(2):210-23
references: 19200528
references: J Health Econ. 1999 Apr;18(2):153-71
references: 10346351
references: Ann Intern Med. 1997 Oct 15;127(8 Pt 2):757-63
references: 9382394
references: Med Decis Making. 2010 May-Jun;30(3):304-13
references: 19815659
references: Eur J Health Econ. 2012 Feb;13(1):39-50
references: 20878439
references: Health Econ. 1994 Sep-Oct;3(5):333-45
references: 7827649
references: Gut. 2004 Oct;53(10):1471-8
references: 15361497
references: Health Policy. 1993 Nov;26(1):29-42
references: 10130844
references: Med Care. 2009 Jul;47(7 Suppl 1):S104-8
references: 19536020
references: Heart. 2002 Dec;88(6):597-603
references: 12433888
references: Addiction. 2006 Mar;101(3):315-22
references: 16499503
references: Pharmacoeconomics. 2011 Aug;29(8):653-71
references: 21604822
references: Respir Med. 2012 Apr;106(4):540-8
references: 22100535
references: Chest. 2003 Mar;123(3):784-91
references: 12628879
references: Respir Med. 1999 Nov;93(11):779-87
references: 10603626
references: Pharmacoeconomics. 2006;24(9):869-90
references: 16942122
references: Ann Rheum Dis. 2004 Apr;63(4):395-401
references: 15020333
references: Eur J Health Econ. 2013 Dec;14(6):1035-48
references: 23275043
references: Diabet Med. 2006 Mar;23(3):299-305
references: 16492214