Comparison of Benefit Estimation models in Cost-Benefit Analysis of Chronic Disease

초록

Objectives When cost-benefit analysis (CBA) is conducted, the method how to estimate accurate benefits is controversial issues. In this study, we compared three different benefit estimation models for showing which model can measure social benefits more precisely. Methods Benefit Estimation Models Three benefit estimation models were selected to show the differences of estimated benefits as follows. First was traditional deterministic estimation model (TDEM) that used pre-post design in which benefit/cost ratio (BCR) was measured as the differences between the first and the third stage in this study. Second was repeated measure deterministic estimation model (RMDEM) that used repeated measure design in which the BCR was measured at each stage. Third was transitional probability estimation model (TPEM) that considered all possibility of status transition at patient level in which the BCR was measured based on all transitional path probabilities at each stage. Unit of Benefits Benefit was estimated by three items: saved outpatient clinic charge, saved hospital admission charge, and saved cost for prevention of severe complications of hypertension. To estimate benefits more precisely, hypertension was classified by three groups according to severity. Statistic Method Ordinal logistic regression was applied to estimate transitional probability. Results Total benefit using the TDEM was estimated as $24,\mathrm{955.03.}TotalbenefitusingtheRMDEMwasestimatedas$19,932.60. And total benefit using TPEM considering all possibility of status changes was estimated as $18,559.47. Conclusions Depending on which measurement methods are used, BCRs show different results. Of the three methods, TPEM showed most accurate as it traced all possible paths of changing status at the individual level and accounted both positive and negative benefits. TPEM may be used for more accurate estimation of the benefit of the program and increasing the quality of decision making