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Related Experiment Videos

Using multilevel models for assessing the variability of multinational resource use and cost data.

Richard Grieve1, Richard Nixon, Simon G Thompson

  • 1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. richard.grieve@lshtm.ac.uk

Health Economics
|September 24, 2004
PubMed
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Multilevel models (MLMs) are more appropriate than ordinary least-squares (OLS) regression for analyzing international healthcare cost variations. MLMs accurately identify factors influencing hospital length of stay and costs across countries.

Area of Science:

  • Health Economics
  • Statistical Modeling
  • International Healthcare Research

Background:

  • Multinational economic evaluations often pool cost data, assuming uniformity across countries.
  • Assessing cost variation requires identifying factors influencing resource use and expenditure.
  • Ordinary least-squares (OLS) regression has been traditionally used but may not suit hierarchical data.

Purpose of the Study:

  • To compare the appropriateness of OLS and multilevel models (MLMs) for analyzing international cost variations.
  • To identify patient- and center-level factors associated with length of hospital stay (LOS) and total cost in stroke admissions across European countries.
  • To evaluate the validity of pooling international cost data.

Main Methods:

  • Utilized a multinational dataset of 1300 stroke admissions from 13 centers in 11 European countries.

Related Experiment Videos

  • Employed both OLS and MLMs to estimate the effects of patient and center covariates on LOS and total cost.
  • Compared MLMs with normal and gamma distributions for within-center data.

    • Main Results:

    • OLS models indicated both patient and center factors influenced LOS and total cost.
    • MLMs revealed no center-level characteristics affected LOS.
    • Health spending level was the primary center-level factor associated with total cost in MLM analyses.

    Conclusions:

    • OLS regression can lead to incorrect inferences when assessing international cost variation.
    • MLMs are more suitable for accurately analyzing variations in resource use and healthcare costs across different centers and countries.
    • Findings highlight the importance of appropriate statistical methods in multinational health economic evaluations.