Is the whole larger than the sum of its parts? Impact of missing data imputation in economic evaluation conducted alongside randomized controlled trials

Bernhard Michalowsky (), Wolfgang Hoffmann (), Kevin Kennedy () and Feng Xie ()
Additional contact information
Bernhard Michalowsky: Site Rostock/Greifswald
Wolfgang Hoffmann: Site Rostock/Greifswald
Kevin Kennedy: McMaster University
Feng Xie: McMaster University

The European Journal of Health Economics, 2020, vol. 21, issue 5, No 5, 717-728

Abstract: Abstract Outcomes in economic evaluations, such as health utilities and costs, are products of multiple variables, often requiring complete item responses to questionnaires. Therefore, missing data are very common in cost-effectiveness analyses. Multiple imputations (MI) are predominately recommended and could be made either for individual items or at the aggregate level. We, therefore, aimed to assess the precision of both MI approaches (the item imputation vs. aggregate imputation) on the cost-effectiveness results. The original data set came from a cluster-randomized, controlled trial and was used to describe the missing data pattern and compare the differences in the cost-effectiveness results between the two imputation approaches. A simulation study with different missing data scenarios generated based on a complete data set was used to assess the precision of both imputation approaches. For health utility and cost, patients more often had a partial (9% vs. 23%, respectively) rather than complete missing (4% vs. 0%). The imputation approaches differed in the cost-effectiveness results (the item imputation: − 61,079€/QALY vs. the aggregate imputation: 15,399€/QALY). Within the simulation study mean relative bias (

Keywords: Missing data; Multiple imputation; Cost-effectiveness analysis; Cost–utility analysis (search for similar items in EconPapers)
JEL-codes: C18 C43 I1 I10 (search for similar items in EconPapers)
Date: 2020
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DOI: 10.1007/s10198-020-01166-z

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