District hospitals in Kenya play a crucial role in the country's healthcare system, serving as primary care providers for millions of people across various regions. A systematic literature review was conducted to identify and analyse studies that employed panel-data estimation methods for measuring cost-effectiveness. The search included articles published between and in English-language databases relevant to healthcare economics and public health. The analysis revealed a significant variation in the application of econometric models, with some studies using linear regression models without accounting for potential endogeneity issues, thereby limiting the robustness of their cost-effectiveness estimates. Despite methodological limitations identified, this review underscores the need for improved statistical methodologies to enhance the reliability and validity of cost-effectiveness evaluations in district hospital systems. Future research should prioritise the use of more sophisticated econometric techniques that can address endogeneity issues, such as instrumental variables or fixed-effects models, to ensure more accurate cost-effectiveness measurements. Treatment effect was estimated with logit (pᵢ) =₀+^ Xᵢ, and uncertainty reported using confidence-interval based inference.
Wanyonyi et al. (Sat,) studied this question.