Approche "multi-états" dynamique des coûts médicaux : Application dépistage pré-thérapeutique des toxicités du 5-FU proposé par le CPP
Résumé
We propose a method of total medical cost assessment over a finished period of time. It is based on the idea of health states and the costs which are associated with them, varying in the time Costs are generated by the stays in health states at each time. A model "multi-states" is used to model the process of arisen the various types of events; the probability between the various health states are estimated by Aalen-Johansen estimator generalizing the Kaplan-Meier estimator of survival function. A mixed-effect model is used for the sojourn costs in states, with transition time as random effect and the variables relative to the patients as fixed effect. This joint model of costs and events of interest allows on one hand to consider the average cost medical accrue in the time and the incidences of the events which generate them, and on the other hand to compare two therapeutic strategies in terms of net benefit The method allows taking into account correctly the heteroscedasticity of the medical costs, recurrent events, censoring, and the terminal event. Asymptotic properties of the mean medical cost estimator are studied. The method is applied to assess the medical and economic interest of the pre-therapeutic screening of the toxicity of the 5-FU proposed by the Centre Paul Papin on 1742 patients distributed in two arms: 856 patients treated according to the strategy of screening and 886 patients treated according to the standard strategy.
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