Watson Samuel, Arulampalam Wiji, Petrou Stavros
Warwick Medical School, University of Warwick, Coventry, UK.
Department of Economics, University of Warwick, Coventry, UK.
Health Econ. 2017 Dec;26(12):e274-e284. doi: 10.1002/hec.3503. Epub 2017 May 12.
The relationship between health care expenditure and health outcomes has been the subject of recent academic inquiry in order to inform cost-effectiveness thresholds for health technology assessment agencies. Previous studies in public health systems have relied upon data aggregated at the national or regional level; however, there remains debate about whether the supply side effect of changes to expenditure are identifiable using data at this level of aggregation. We use detailed patient data derived from electronic neonatal records across England along with routinely available cost data to estimate the effect of changes to patient expenditure on clinical health outcomes in a well-defined patient population. A panel of 32 neonatal intensive care units for the period 2009-2013 was constructed. Accounting for the potential endogeneity of expenditure a £100 increase in the cost per intensive care cot day (sample average cost: £1,127) is estimated to reduce the risk of mortality of 0.38 percentage points (sample average mortality: 11.0%) in neonatal intensive care. This translates into a cost per life saved in neonatal intensive care of approximately £420,000.
医疗保健支出与健康结果之间的关系一直是近期学术研究的主题，目的是为卫生技术评估机构提供成本效益阈值信息。此前在公共卫生系统进行的研究依赖于国家或地区层面汇总的数据；然而，对于能否使用该汇总层面的数据来确定支出变化的供应方效应，仍存在争议。我们使用源自英格兰各地电子新生儿记录的详细患者数据以及常规可得的成本数据，来估计在明确界定的患者群体中患者支出变化对临床健康结果的影响。构建了一个由2009 - 2013年期间32个新生儿重症监护病房组成的样本。考虑到支出的潜在内生性，估计重症监护病床日成本每增加100英镑（样本平均成本：1127英镑），新生儿重症监护中死亡风险会降低0.38个百分点（样本平均死亡率：11.0%）。这意味着新生儿重症监护中每挽救一条生命的成本约为42万英镑。
