Methodological Evaluation of District Hospitals Systems in Ethiopia Using a Difference-in-Differences Approach for Cost-Effectiveness Analysis

District hospitals in Ethiopia face challenges in cost-effectiveness, necessitating a methodological evaluation to improve their systems. A DID approach was employed to analyse data from baseline and follow-up periods, with control districts used as comparators. Uncertainty in estimates is quantified through robust standard errors. District hospitals showed a significant improvement in patient outcomes (p < 0. 05) after the intervention period compared to non-intervention districts. The DID model effectively measured cost-effectiveness, providing actionable insights for resource allocation and system improvements. Implementing identified interventions could enhance service delivery efficiency and improve health outcomes in district hospitals. Difference-in-Differences, Cost-Effectiveness, District Hospitals, Ethiopia Treatment effect was estimated with logit (pᵢ) =₀+^ Xᵢ, and uncertainty reported using confidence-interval based inference.