Multivariate cost-effectiveness analysis: an application to optimizing ambulatory care for hypertension.

Cost-effectiveness analysis (CEA) is being used increasingly to allocate health resources efficiently. This paper develops an extension of CEA based on multivariate regression analysis and applies it to hypertension treatment. After assembling clinic and patient characteristics, outcomes, and costs for 2,439 randomly chosen patients in the 32 special hypertension clinics of the Department of Veterans Affairs (VA), we identified 19 significant predictors of cost and diastolic blood pressure (DBP) using multiple regression analysis. We classified these independent variables as "unambiguous" if a given change was associated with both lower cost and better DBP, or as "trade-off" variables if any change improving DBP entailed higher costs. The results suggest that fully implementing all unambiguous clinic changes would reduce costs by 33% while improving DBP. Multivariate CEA could help managed care companies and government programs with cost and outcome data to reduce costs and improve outcomes.

Motorcycle accident injury severity, blood alcohol levels, insurance status, and hospital costs: a 4-year study in St. Petersburg, Florida.

Clinical, demographic, and financial information for 337 patients injured in motorcycle accidents who were admitted to a community hospital over a 4-year period was reviewed for injury severity, prevalence and degree of alcohol intoxication, and effects of insurance status on hospital, patient, and community costs. Ninety percent of the patients were males (average age 31 years), and 52% had some form of insurance. Of those tested at the time of admission, 36% had blood alcohol levels of > or = 100 mg%. Uninsured patients had higher blood alcohol levels (p = 0.0001), as did older patients (p = 0.01). Forty percent of patients had injury severity scores of > or = 16. Uncompensated costs to the hospital of caring for the uninsured totalled > $850,000 over the 4 years. The need to enforce existing statutes and to increase awareness through education is discussed, and statutory changes are recommended.