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Original Articles

Generalized Redistribute-to-the-Right Algorithm: Application to the Analysis of Censored Cost Data

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Pages 304-323
Received 02 Dec 2011
Accepted 01 Nov 2012
Accepted author version posted online: 25 Feb 2013
Published online:05 Apr 2013
 

Medical cost estimation is a challenging task when censoring of data is present. Although researchers have proposed methods for estimating mean costs, these are often derived from theory and are not always easy to understand. We provide an alternative method, based on a replace-from-the-right algorithm, for estimating mean costs more efficiently. We show that our estimator is equivalent to an existing one that is based on the inverse probability weighting principle and semiparametric efficiency theory. We also propose an alternative method for estimating the survival function of costs, based on the redistribute-to-the-right algorithm, that was originally used for explaining the Kaplan–Meier estimator. We show that this second proposed estimator is equivalent to a simple weighted survival estimator of costs. Finally, we develop a more efficient survival estimator of costs, using the same redistribute-to-the-right principle. This estimator is naturally monotone, more efficient than some existing survival estimators, and has a quite small bias in many realistic settings. We conduct numerical studies to examine the finite sample property of the survival estimators for costs, and show that our new estimator has small mean squared errors when the sample size is not too large. We apply both existing and new estimators to a data example from a randomized cardiovascular clinical trial.

Acknowledgments

The authors thank Dr. Heejung Bang for her motivating ideas for this article. We also thank Dr. Arthur Moss and the Boston Scientific for use of their data in our example. We thank reviewers for providing constructive comments. This research was supported by R01 HL096575 from the National Heart, Lung, and Blood Institute.

 

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