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The analysis of incomplete cost data due to dropout

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Author Info
Jan B. Oostenbrink (Institute for Medical Technology Assessment, Erasmus MC, Rotterdam, The Netherlands)
Maiwenn J. Al (Institute for Medical Technology Assessment, Erasmus MC, Rotterdam, The Netherlands)
Abstract

Incomplete data due to premature withdrawal (dropout) constitute a serious problem in prospective economic evaluations that has received only little attention to date. The aim of this simulation study was to investigate how standard methods for dealing with incomplete data perform when applied to cost data with various distributions and various types of dropout. Selected methods included the product-limit estimator of Lin et al. the expectation maximisation (EM-) algorithm, several types of multiple imputation (MI) and various simple methods like complete case analysis and mean imputation. Almost all methods were unbiased in the case of dropout completely at random (DCAR), but only the product-limit estimator, the EM-algorithm and the MI approaches provided adequate estimates of the standard error (SE). The best estimates of the mean and SE for dropout at random (DAR) were provided by the bootstrap EM-algorithm, MI regression and MI Monte Carlo Markov chain. These methods were able to deal with skewed cost data in combination with DAR and only became biased when costs also included the costs of expensive events. None of the methods were able to deal adequately with informative dropout. In conclusion, the EM-algorithm with bootstrap, MI regression and MI MCMC are robust to the multivariate normal assumption and are the preferred methods for the analysis of incomplete cost data when the assumption of DCAR is not justified. Copyright © 2005 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.966
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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 14 (2005)
Issue (Month): 8 ()
Pages: 763-776
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Handle: RePEc:wly:hlthec:v:14:y:2005:i:8:p:763-776

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. O'Hagan, Anthony & Stevens, John W., 2004. "On estimators of medical costs with censored data," Journal of Health Economics, Elsevier, vol. 23(3), pages 615-625, May. [Downloadable!] (restricted)
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  1. M. Carreras & Manuel García-Goñi & Pere Ibern & J. Coderch & L. Vall-Llosera & José María Inoriza, 2009. "Estimates of patient costs related with population morbidity: can indirect costs affect the results?," Economics Working Papers 1138, Department of Economics and Business, Universitat Pompeu Fabra. [Downloadable!]
  2. M. Carreras & Manuel García-Goñi & Pere Ibern & J. Coderch & L. Vall-Llosera & José María Inoriza, 2009. "Estimates of patient costs related with population morbidity: can indirect costs affect the results?," Working Papers, Research Center on Health and Economics 1138, Department of Economics and Business, Universitat Pompeu Fabra. [Downloadable!]
  3. David K. Blough & Scott Ramsey & Sean D. Sullivan & Roger Yusen, 2009. "The impact of using different imputation methods for missing quality of life scores on the estimation of the cost-effectiveness of lung-volume-reduction surgery," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 91-101. [Downloadable!]
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