Unbiased Analysis of Today's Healthcare Issues
It seems like everything just gets more and more expensive. But are prices for medical care declining? Cutler et al. (1998) found in seminal paper “Are medical prices declining? Evidence for heart attack treatments” that while unadjusted prices of medical care were in fact rising, quality-adjusted health care costs actually were falling. In my own…
What should you do when you want to conduct a cost-effectiveness analysis based on efficacy estimates from clinical trials but the trial has missing data. One common approach—known as complete case analysis (CCA)—is to discard the participants with incomplete observations. This approach is problematic as not only is there a loss in efficiency of the…
Imagine that you are a policymaker and an academic researcher shows you evidence for a new health intervention that will dramatically improve health outcomes. He shows you the study results, the estimated impact and a p-value that is less than 0.05. How much credibility should you give to this result? What quantiative approach should you…
A paper by Holmberg et al. (2022) in JAMA provides a number of examples of how collider bias can lead to problematic causal inference. The term collider bias is often invoked when using directed acyclic graphs (DAGs) to map the causal pathway. Collider bias occurs when you aim to measure the impact of A on…
This is the goal of a paper by Yang et al. (2022) out in Health Economics. They first provide a nice review of the literature and divide the methodologies around risk taking into type types. I briefly summarize that literature below. Direct methods. These methods may ask individuals about their attitude toward risk or likelihood…
Most people know what accuracy means. Find out how many guesses you made and how many of those guesses you got correct. In the case of a diagnostic test, this is simply the number of correct answers (true positives plus true negatives) divided by the total number of answers (true positives + false positives +…
When you want to measure the causal impact of an intervention, there are a number of different approaches. Difference in difference (DiD) and the synthetic control method (SCM) are two common methods, each of which I have already provided econometric overview summaries (DiD, SCM). A paper by Arkhangelsky et al (2021) in AER summarizes the…
Supposed you have some data on health care spending for different individuals and you want to know which patient characteristics increase health care spending. While this seems like something any health economist could do, measuring the relationship require both knowing (i) which independent variables to include in your data analysis and (ii) their functional form.…
I have written previously about the need for distributional cost-effectiveness analysis (DCEA) which would increase the value of treatments who improve the health for individuals who currently have the worst expected quality-adjusted life expectancy (QALE). I’ve written about this in AJMC and Health Affairs among other places. One key question many individuals may have is…
FDA draft guidance published this month says you should. In most cases, adjusting for covariates is not necessary. Randomization generally insurers that covariates are balanced across clinical trial arms. Randomization, however, may not always result in perfectly balanced trial arms. In these cases, the FDA notes that covariate adjustment is perfectly acceptable. There are some…