醫療成本發生率函數之平滑估計法

目前有關醫療成本分析的研究，都集中於建構總成本或者特定時間區域成本的模型，以及其相關的統計推論。然而在這些分析裹，發生成本的時間並沒有被納入模型內，有部份的資訊沒有被完整用。在這篇論文中，我們進一步地結合發生成本的時間及相對應的成，來探討成本發生率函數，為了深入研究解釋變數和成本發生率函數之間的關係，我們建立了一個更具延伸性和解釋性的廣義時間變異參數線性模型。根據截切資料，我們提供平滑估計法以便估計參數函數，接著，我們也對估計函數的變異矩陣提出一個估計式，利用估計式的常態分配逼近，其相對應的信賴區間建構法也被提出。我們執行了一系列的模擬檢證這些估計式以及信賴區間在有限樣本下之特性，此外，應用所提出的估計法在 SEER-Medicare資料庫有關結腸癌的資料上。

關鍵字

醫療成本；存活；發生率

並列摘要

Most of recent research into medical cost analysis has focused on developing appropriate models and statistical inferences for the accumulated cost up to the end of study or the pre-determined times within the study period. However, the time of medical cost occurrence was not fully characterized in the total cost. In this thesis, we consider the model for the rate function of occurrence medical cost which uses the information of cost and occurrence times. To explore the association of the covariates with the rate function, a more flexible and easily explained time-varying coefficient generalized linear model is established to account for the heteroscedasticity. Based on censored data, a smoothing estimation method is proposed to estimate the parameter functions. Moreover, a consistent estimator for the asymptotic variance matrix of the estimators is provided. The limiting distribution of estimated functions and the estimator of variance matrix enable us to construct approximated regions. To investigate the finite sample properties of the estimators and the performance of procedure for the construction of confidence intervals, a class of simulations is conducted. An application to the colorectal cancer data retrieved from the Surveillance, Epidemiology, and End Results (SEER) Medicare database is further presented.

並列關鍵字

bandwidth ； boundary kernel weight function ； censoring ； generalized linear model ； inverse probability of survival weighting ； occurrence medical cost ； rate function ； smoothing estimation

參考文獻

[1] Bang, H. (2000). Estimating medical costs with censored data. Biometrika, 87(2), 329-343.

[2] Bang, H. (2005). Medical cost analysis: Application to colorectal cancer data from the SEER Medicare database. Contemporary Clinical Trials, 26, 586-597.

[3] Dodd, L. E., Pepe, M. S. (2003). Semiparametric regression for the area under the receiver operating characteristic curve. Journal of the American Statistical Association, 98(462), 409-417.

[4] Foutz, R. V. (1977). On the unique consistent solution to the likelihood equations. Journal of the American Statistical Association, 72(357), 147-148.

[6] Lin, D. Y., Feuer, E. J., Etzioni, R., Wax, Y. (1997). Estimating medical costs from incomplete follow-Up data. Biometrics, 53, 419-434.

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醫療成本發生率函數之平滑估計法

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