Revealing age-specific past and future unrelated costs of pneumococcal infections by flexible generalized estimating equations
We aimed to study the excess health-care expenditures for persons with a known positive isolate of Streptococcus pneumoniae. The data set was compiled by linking the database of the largest Belgian Sickness Fund with data obtained from laboratories reporting pneumococcal isolates.
We analyzed the age-specific per-patient cumulative costs over time, using generalized estimating equations (GEEs). The mean structure was described by fractional polynomials. The quasi-likelihood under the independence model criterion was used to compare different correlation structures.
We show for all age groups that the health-care costs incurred by diagnosed pneumococcal patients are significantly larger than those incurred by undiagnosed matched persons. This is not only the case at the time of diagnosis but also long before and after the time of diagnosis. These findings
can be informative for the current debate on unrelated costs in health economic evaluation, and GEEs could be used to estimate these costs for other diseases. Finally, these results can be used to inform policy on the expected budget impact of preventing pneumococcal infections.
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generalized estimating equations;
Document Type: Research Article
Interuniversity Institute for Biostatistics,Hasselt University and Catholic University of Leuven, Belgium
Medical Direction, National Alliance of Christian Mutualities, Brussel, Belgium
Centre for Health Economics Research and Modeling Infectious Diseases, Centre for the Evaluation of Vaccination, and Vaccine and Infectious Disease Institute,University of Antwerp, Antwerp, Belgium
August 1, 2011