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Improving costing methods in multicentre economic evaluation: the use of multiple imputation for unit costs


  • Richard Grieve
  • John Cairns
  • Simon G. Thompson


Economic evaluations must use appropriate costing methods. However, in multicentre cost‐effectiveness analyses (CEA) a fundamental issue of how best to measure and analyse unit costs has been neglected. Multicentre CEA commonly take the mean unit cost from a national database, such as NHS reference costs. This approach does not recognise that unit costs vary across centres and are unavailable in some centres. This paper proposes the use of multiple imputation (MI) to predict those centre‐specific unit costs that are not available, while recognising the statistical uncertainty surrounding this imputation. We illustrate MI with a CEA of a multicentre randomised trial (1014 patients, 60 centres), implemented using multilevel modelling. We use MI to derive centre‐specific unit costs, based on centre characteristics including average casemix, and compare this to using mean NHS reference costs. In this case study, using MI unit costs rather than mean reference costs led to less heterogeneity across centres, more precise estimates of incremental cost, but similar estimates of incremental cost‐effectiveness. We conclude that using MI to predict unit costs can preserve correlations, maximise the use of available data, and, when combined with multilevel modelling is an appropriate method for recognising the statistical uncertainty in multicentre CEA. Copyright © 2009 John Wiley & Sons, Ltd.

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  • Richard Grieve & John Cairns & Simon G. Thompson, 2010. "Improving costing methods in multicentre economic evaluation: the use of multiple imputation for unit costs," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 939-954, August.
  • Handle: RePEc:wly:hlthec:v:19:y:2010:i:8:p:939-954
    DOI: 10.1002/hec.1531

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    References listed on IDEAS

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    1. Lukas Kwietniewski & Mareike Heimeshoff & Jonas Schreyögg, 2017. "Estimation of a physician practice cost function," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(4), pages 481-494, May.
    2. Adrian Gheorghe & Tracy Roberts & Thomas D. Pinkney & Dion G. Morton & Melanie Calvert, 2015. "Rational Centre Selection for RCTs with a Parallel Economic Evaluation—the Next Step Towards Increased Generalisability?," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 498-504, April.
    3. Manuel Gomes & Karla Díaz-Ordaz & Richard Grieve & Michael G. Kenward, 2013. "Multiple Imputation Methods for Handling Missing Data in Cost-effectiveness Analyses That Use Data from Hierarchical Studies," Medical Decision Making, , vol. 33(8), pages 1051-1063, November.

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