Cost-Effectiveness Analysis of District Hospitals Systems in Ethiopia Using Multilevel Regression Models

District hospitals in Ethiopia play a crucial role in healthcare delivery, yet their cost-effectiveness remains underexplored. A comprehensive analysis was conducted on data from multiple districts across Ethiopia. Multilevel regression models were applied to assess the impact of various factors such as geographical location, patient demographics, and healthcare service delivery on cost-effectiveness metrics. The multilevel regression analysis revealed significant variations in cost-effectiveness among different regions with a notable proportion (25%) of districts showing underutilization of available resources despite high expenditure. Our findings underscore the need for targeted interventions to optimise resource allocation and improve service delivery efficiency within district hospitals. Policy makers should prioritise investment in infrastructure and human capital, particularly in underserved regions where cost-effectiveness is compromised. district hospitals, Ethiopia, multilevel regression, cost-effectiveness, healthcare systems Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.