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Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery.

Publication ,  Journal Article
Dudley, RA; Harrell, FE; Smith, LR; Mark, DB; Califf, RM; Pryor, DB; Glower, D; Lipscomb, J; Hlatky, M
Published in: J Clin Epidemiol
March 1993

The cost of treating disease depends on patient characteristics, but standard tools for analyzing the clinical predictors of cost have deficiencies. To explore whether survival analysis techniques might overcome some of these deficiencies in the analysis of cost data, we compared ordinary least square (OLS) linear regression (with and without transformation of the data) and binary logistic regression with two survival models: the Cox proportional hazards model and a parametric model assuming a Weibull distribution. Each model was applied to data from 155 patients undergoing coronary artery bypass grafting. We examined the effects of age, sex, ejection fraction, unstable angina, and number of diseased vessels on univariable and multivariable predictions of costs. The significant univariable predictors of cost were consistent in all models: ejection fraction was significant in all five models, and age and number of diseased vessels were each significant in all but the OLS model, while sex and angina type were significant in none of the models. The significant multivariable predictors of cost, however, differed according to model: ejection fraction was a significant multivariable predictor of cost in all five models, age was significant in three models, and number of diseased vessels was significant in one model. All five models were also used to predict the costs for an average patient undergoing surgery. The Cox model provided the most accurate predictions of mean cost, median cost, and the proportion of patients with high cost. This study shows: (1) lower ejection fraction and older age are independent clinical predictors of increased cost of CABG, and (2) the Cox proportional hazards model shows considerable promise for the analysis of the impact of clinical factors upon cost.

Duke Scholars

Published In

J Clin Epidemiol

DOI

ISSN

0895-4356

Publication Date

March 1993

Volume

46

Issue

3

Start / End Page

261 / 271

Location

United States

Related Subject Headings

  • United States
  • Regression Analysis
  • Prospective Studies
  • Proportional Hazards Models
  • Normal Distribution
  • Middle Aged
  • Male
  • Logistic Models
  • Linear Models
  • Least-Squares Analysis
 

Citation

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MLA
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Dudley, R. A., Harrell, F. E., Smith, L. R., Mark, D. B., Califf, R. M., Pryor, D. B., … Hlatky, M. (1993). Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery. J Clin Epidemiol, 46(3), 261–271. https://doi.org/10.1016/0895-4356(93)90074-b
Dudley, R. A., F. E. Harrell, L. R. Smith, D. B. Mark, R. M. Califf, D. B. Pryor, D. Glower, J. Lipscomb, and M. Hlatky. “Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery.J Clin Epidemiol 46, no. 3 (March 1993): 261–71. https://doi.org/10.1016/0895-4356(93)90074-b.
Dudley RA, Harrell FE, Smith LR, Mark DB, Califf RM, Pryor DB, et al. Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery. J Clin Epidemiol. 1993 Mar;46(3):261–71.
Dudley, R. A., et al. “Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery.J Clin Epidemiol, vol. 46, no. 3, Mar. 1993, pp. 261–71. Pubmed, doi:10.1016/0895-4356(93)90074-b.
Dudley RA, Harrell FE, Smith LR, Mark DB, Califf RM, Pryor DB, Glower D, Lipscomb J, Hlatky M. Comparison of analytic models for estimating the effect of clinical factors on the cost of coronary artery bypass graft surgery. J Clin Epidemiol. 1993 Mar;46(3):261–271.
Journal cover image

Published In

J Clin Epidemiol

DOI

ISSN

0895-4356

Publication Date

March 1993

Volume

46

Issue

3

Start / End Page

261 / 271

Location

United States

Related Subject Headings

  • United States
  • Regression Analysis
  • Prospective Studies
  • Proportional Hazards Models
  • Normal Distribution
  • Middle Aged
  • Male
  • Logistic Models
  • Linear Models
  • Least-Squares Analysis