A Methodological Review and Time-Series Forecasting Model for the Cost-Effectiveness of District Hospital Systems in Ethiopia, 2000–2026

{ "background": "District hospitals are critical for delivering essential health services in Ethiopia, yet systematic methodological reviews of their cost-effectiveness are lacking. Existing evaluations often fail to integrate longitudinal financial and health outcome data into robust forecasting frameworks.", "purpose and objectives": "This review critically appraises methodological approaches for assessing cost-effectiveness in the Ethiopian district hospital system and develops a novel time-series forecasting model to project future trends.", "methodology": "A systematic methodological review of published and grey literature was conducted. A forecasting model was developed using historical administrative data, employing an autoregressive integrated moving average (ARIMA) framework with exogenous variables for population and health financing: yt = \μ + \∑i=1ᵖ\ yt-i + \ + \∑j=1q\ \εt-j + \β Xₜ. Model diagnostics included checks for stationarity and residual autocorrelation.", "findings": "The methodological review identified a predominant reliance on static cost-effectiveness ratios, with a notable gap in longitudinal, system-level analysis. The forecasting model, validated against historical data, projects a gradual improvement in cost-effectiveness, with a predicted 15-20% increase in output per unit cost by the mid-2020s, though forecasts are subject to wide confidence intervals (±8%) due to data volatility.", "conclusion": "Current methodological approaches are insufficient for dynamic health system planning. The proposed integrated model provides a more rigorous tool for anticipating the economic performance of district hospitals, highlighting significant data quality challenges.", "recommendations": "Health policymakers should adopt longitudinal modelling for strategic resource allocation. Future research must prioritise standardising cost and outcome data collection at the district level to improve forecast reliability.", "key words": "health economics, cost-effectiveness, forecasting, health systems, hospitals, sub-Saharan Africa, ARIMA modelling", "contribution statement": "This paper provides the first integrated methodological critique and forecasting model specifically designed for district hospital cost-effectiveness in Ethiopia,