This preview shows page 31 - 34 out of 39 pages. Subscribe to view the full document. I cannot even describe how much Course Hero helped me this summer. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero. DeAnza College. ECON 1.
The statistical analysis of economic data is referred to as A microeconomics B
The statistical analysis of economic data is referred. Bestselling Series. Harry Potter. Popular Features. New Releases. Analysis of Economic Data. Description Analysis of Economic Data has, over three editions, become firmly established as a successful textbook for students studying data analysis whose primary interest is not in econometrics, statistics or mathematics.
It introduces students to basic econometric techniques and shows the reader how to apply these techniques in the context of real-world empirical problems. The book adopts a largely non-mathematical approach relying on verbal and graphical inuition and covers most of the tools used in modern econometrics research. It contains extensive use of real data examples and involves readers in hands-on computer work. Incremental cost-effectiveness ratio ICER. With the availability of patient level data on costs and effects it is possible to summarize uncertainty in the ICER as a confidence interval.
As cost data are typically not normally distributed, non-parametric bootstrapping will be used to generate confidence intervals. Lifetime incremental cost-utility ratios will be estimated using bootstrap estimation methods [ 39 , 40 ], and using data and simplifying assumptions described in previous paragraphs.
Assumption of linear increasing utility for survivors over first 6 months. It would be beneficial to health care decision makers if economic study results could be generalised from one setting to another as this would avoid having to repeat every study in every setting.
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Factors which may vary in different settings are: unit costs of resources, geographical variations in demography or epidemiology of disease, clinical practice patterns, incentives to health care professionals and availability of resources. To facilitate estimation of the transferability of economic data from the CESAR trial to other health care setting, such factors in the study population will be described, and resource use and prices reported separately. The CESAR Trial was funded with full economic support from the design stages of the trial with funding for two part-time health economists which helped the economic research team to tackle many challenges in the design, methods, data collection, developing and piloting the economic questionnaire and planning the analysis.
The trial protocol was developed in collaboration with health economists, who are members of the Trial Steering Committee, and an economics working group oversees the economic data collection and analysis. Incorporation of economic evaluations within randomised controlled trials of medical therapies has been a growing trend in the past decade.
Many health care systems in developed countries now use economic evaluations as a formal input to decisions about whether to fund new technologies. Economic evaluations conducted alongside randomised trials are meant to inform decision-makers about the economic benefit of the technology under investigation. The information will shed the most light on the question of 'value for money' if the trial and the evaluation are properly designed, if appropriate data are collected and correctly analysed, and if the many sources of uncertainly surrounding these evaluations are adequately addressed.
The past decade has seen a large increase in the number of published economic evaluations as well as improvements in economic evaluation techniques. However, much debate and confusion still persist among analysts, readers, and policy- makers concerning methods and the overall usefulness of CEA in resource allocation decision making.
A number of potential reasons may account for this, among them political expediency, social preferences and systemic barriers to implementation. In addition, there are a number of more technical shortcomings associated with the generation of economic evidence including methodological inconsistency across completed economic evaluations and the limited generalisability or transferability of findings or settings beyond the location of the original study. The economic evaluation methodology described in this paper aims to address these issues and guidelines and recommendations from more recent publications in methods for economics and trials [ 44 ] were used in the design and conduct of the evaluation and the planned analysis.
The CESAR Trial was funded with full economic support from the design stages of the trial with funding for three part-time health economists which helped the economic research team to tackle many challenges in the design, methods, data collection, developing and piloting the economic questionnaire and planning the analysis. The trial protocol was developed in collaboration with health economists, who were members of the trial steering group, and an economics working group including the trial manager and leaders have overseen the economic evaluation.
The strengths of the trial on which this economic evaluation was based are that it was randomised and controlled, pragmatic in design, and provided a vehicle for collecting a comprehensive set of data on resource use and clinical effectiveness. These provide a reliable basis for estimating the economic efficiency of ECMO for adults with severe respiratory failure. The study cost accounting was comprehensive and included most major health service cost items. Most unit costs used for valuation of reported resources used were from published national sources and where unit costs were unavailable rigorous methods were used for their estimation and the methods used clearly described.
Unit costs for ICU stays were estimated for every centre that recruited a patient which was then weighted for each patient to reflect the level of care and number of organs supported during the acute phase of the illness. Very few resource items were excluded from the data collection process alongside the trial. Presenting this methodology paper before the end of the trial is an attempt to make transparent the methods used for the evaluation, and to allay concern of manipulation of economics results.
Zvi Griliches, 69, an Authority On Analysis of Economic Data
In our view it is important to record our methods in detail and present before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. There are aspects of the planned methods that may be seen as idealistic. In particular, our estimation of resource use after hospital discharge is based on patients' reports after a traumatic period in their lives of many different aspects of service use and personal costs.
The aggregate cost variables are made up from a combination of this large number of reported items, many of which may be missing. Although complete case analysis is our primary method of analysis, we are conscious that this might be quite unrepresentative of the CESAR trial population. Our planned secondary approach is to use imputation of missing values to increase the numbers of patients for whom we can estimate costs. However, this also raises the question about how much detail we actually needed to collect from patients or other sources. Previous researchers have attempted to establish reduced form resource use data for costing [ 45 , 46 ] but have not arrived at any general rules for doing this.
Subject to Steering Group approval, the data from this trial will be available for further analysis of this problem. As a result of this publication of the methods for the economic evaluation in the CESAR trial prior to publication of the results, we shall be open to scrutiny for any changes to protocol in our reported data collection and analysis.
By this means we hope to increase confidence in the results of the economic evaluation. Cost Effectiveness Analysis. Cost Utility Analysis. Extracorporeal membrane oxygenation.
Incremental Cost Effectiveness Ratio. Intensive care unit. National Health Service. Office of National Statistics. Personal Social Services Research Unit. Randomized controlled trial.
United Kingdom. The opinions expressed here are those of the author s and not necessarily those of the UK Government's Department of Health or the Sponsor. Samantha Harris research nurse, Glenfield Hospital helped with piloting the memory aid and resource use questionnaire. The Trial Steering Committee meets every year and is responsible for approving any changes to protocol and monitors and supervises the trial towards achieving its objectives.
Members of the project management group are ex-officio. This represents all the different disciplines involved in the trial.
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Specialist working groups will advise the Steering Committee. This article is published under license to BioMed Central Ltd. Abstract Background Extracorporeal Membrane Oxygenation ECMO is a technology used in treatment of patients with severe but potentially reversible respiratory failure. Discussion In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain.
Previous economic evaluations A literature search failed to find any economic evaluation studies of adult ECMO.
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Economic questions about treatment of severe respiratory failure The economic evaluation addresses the question of value for money of the alternative treatment options. For the CESAR trial relevant aspects of resource use were identified using expert advice managers, medical, nursing and patient representatives all commented on the draft lists and also considering the items included in the economic evaluation of neonatal ECMO [ 12 ].
A list of resource items important from one or more viewpoints is given in Table 1. This includes resource use associated with initial stay in intensive and high dependency care units at different levels of care measured by number of organs supported — see below , use of ambulance transport, stays in other hospital wards before discharge, costs of visiting incurred by relatives whilst patients are in hospital, resource use after discharge up to six months, major changes in household, out-of-pocket expenses of patient and family, loss of paid and unpaid working time, changes in working time, and informal care.
Some, but not all, of these are additional to the instruments planned for the CESAR trial management and clinical outcome data collection [ 11 ]. Data on patients' organ support requirements were collected on a daily basis by the critical care unit staff using specially designed data collection booklets. These data were collected for consecutive admissions during the study period.
At the same time, the intensive care units and hospital finance departments were sent questionnaires to document their monthly expenditure on consumables drugs and fluids, disposable equipment, nutritional products and blood and blood products , staff consultant medical staff and other medical staff , clinical support services radiology tests and laboratory services , professionals allied to medicine physiotherapists, clinical pharmacists, dieticians, medical technical officers, information technologists, clinical and biomedical scientists, speech and language therapists, clinical psychologists and occupational therapists , support staff personnel officers and directorate accountants and specialised bed therapy.
Data were also collected on the organizational characteristics of the intensive care units and the monthly number of patient days, number of staffed beds, number of patient admissions etc. Figure 1 shows the whole process of estimating unit costs of ICU stay, derivation of weights for number of organs supported and how this feeds into the cost estimation in the trial.
Analysis of Economic Data
Figure 1 Unit cost flowchart for hospital critical care. The daily costs per visit estimated in the pilot study are shown in Table 2. The pilot study informed the methods for a multi-centre study in six intensive care units in the UK which are registered with the CESAR trial. The aim was to estimate the average cost of visiting patients in intensive care. All adults including primary carers visiting the intensive care units during a three-week duration were requested to complete a questionnaire that asked them about their time spent in visiting and travel, out-of-pocket expenses, employment status, loss of income etc.