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Cost-effectiveness in clinical trials : using multiple imputation to deal with incomplete cost data

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Burton, Andrea, Billingham, Lucina Jane and Bryan, Stirling. (2007) Cost-effectiveness in clinical trials : using multiple imputation to deal with incomplete cost data. Clinical Trials, Vol.4 (No.2). pp. 154-161. ISSN 1740-7745

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Official URL: http://dx.doi.org/10.1177/1740774507076914

Abstract

Background: Cost-effectiveness has become an important outcome in many clinical trials and has resulted in the collection of resource use data and the calculation of costs for individual patients. A specific example is a Cancer Research UK phase III trial comparing chemotherapy against standard palliative care in patients with advanced non-small cell lung cancer. Resource usage from trial entry until death were collected and costs obtained on a subset of 115 trial patients. For some patients, however, the unavailability of medical notes resulted in some cost components, and hence total cost, being missing. The 82 patients with complete data were not representative of all trial patients in terms of effectiveness and thus it was necessary to address the missing data problem. Methods: Multiple imputation was used to impute values for the unobserved individual cost components, allowing total cost to be calculated and cost-effectiveness carried out for all patients in the cost sub-study. The results are compared with those from a complete case analysis. Results: After multiple imputation, the results indicated that chemotherapy had a high probability of being cost-effective for a societal willingness to pay over £20,000 per life-year gained. This was in stark contrast with the complete case analysis, which suggested that chemotherapy was not a cost-effective use of resources at any reasonable level of willingness to pay for a life-year. Limitations: Our findings are based on a relatively small retrospective study with all events observed. Conclusion: In conclusion, cost-effectiveness analysis of the complete cases only may give biased results, and therefore, in situations where there are missing costs, multiple imputation is recommended.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) Q Science > QA Mathematics
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Cost effectiveness, Missing observations (Statistics), Multiple imputation (Statistics)
Journal or Publication Title:	Clinical Trials
Publisher:	Sage
ISSN:	1740-7745
Official Date:	2007
Volume:	Vol.4
Number:	No.2
Page Range:	pp. 154-161
Identification Number:	10.1177/1740774507076914
Status:	Not Peer Reviewed
Access rights to Published version:	Open Access
Description:	Version accepted by publisher (post-print, after peer review, before copy-editing)
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URI:	http://wrap.warwick.ac.uk/id/eprint/92