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Applied Health Economics and Health Policy

Published in:

01-06-2005 | Original Research Article

Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials

Authors: Dr Andrea Manca, Stephen Palmer

Published in: Applied Health Economics and Health Policy | Issue 2/2005

Abstract

Background

Missing data are potentially an extensive problem in cost-effectiveness analyses conducted alongside randomised clinical trials, where prospective collection of both resource use and health outcome information is required. There are several possible reasons for the presence of incomplete records, and the validity of the analysis in the presence of data with missing values is dependent upon the mechanism generating the missing data phenomenon. In the past, the most commonly used methods for analysing datasets with incomplete observations were relatively ad hoc (e.g. case deletion, mean imputation) and suffered from potential limitations. Recently, several alternative and more sophisticated approaches (e.g. multiple imputation) have been proposed that attempt to correct the flaws of the simple imputation methods.

Objectives

The objectives are to provide a concise and accessible description of the quantitative methods most commonly used in trial-based cost-effectiveness analysis for handling missing data, and also to demonstrate the potential impact of these alternative approaches on the cost-effectiveness results reported in two case studies.

Methods

Data from two recently conducted, trial-based economic evaluations are used to explore the sensitivity of the study results to the technique used to deal with incomplete observations. A statistical framework for representing the uncertainty in the alternative methods is outlined using an approach based on net benefits and cost-effectiveness acceptability curves.

Results

The case studies demonstrate the potential importance of the approach used to handle missing data. Although the analytical strategy did not appear to alter the results of one of the studies, the other case study showed that that the results of the cost-effectiveness analysis were sensitive to both the decision to impute and also the imputation strategy adopted.

Conclusions

Analysts should be more explicit in reporting the analytical strategies applied in the presence of missing data. The use of a multiple imputation approach is recommended in the majority of cases, so as to adequately reflect the uncertainty in the study results due to the presence of missing data.

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¹One scenario in which the CCA estimator is clearly biased is when costs and effects are censored. Lin and colleagues[21] discussed the issue of cost estimation in the presence of censored survival times for some patients in the study. They suggested that the uncensored-cases’ estimator (i.e. CCA) is biased towards the costs of the patients with shorter survival times, because patients with longer survival times are more likely to be censored.

²For an extensive list of papers and reports on both theoretical developments and applications of MI, and for a list of available software to generate MIs, see the website http://www.multiple-imputation.com.

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Title: Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials
Authors: Dr Andrea Manca
Stephen Palmer
Publication date: 01-06-2005
Publisher: Springer International Publishing
Published in: Applied Health Economics and Health Policy / Issue 2/2005
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI: https://doi.org/10.2165/00148365-200504020-00001

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Handling missing data in patient-level cost-effectiveness analysis alongside randomised clinical trials

Abstract

Background

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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