title: A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials.
abstract: Missing data are a frequent problem in cost-effectiveness analysis (CEA) within a randomised controlled trial. Inappropriate methods to handle missing data can lead to misleading results and ultimately can affect the decision of whether an intervention is good value for money. This article provides practical guidance on how to handle missing data in within-trial CEAs following a principled approach: (i) the analysis should be based on a plausible assumption for the missing data mechanism, i.e. whether the probability that data are missing is independent of or dependent on the observed and/or unobserved values; (ii) the method chosen for the base-case should fit with the assumed mechanism; and (iii) sensitivity analysis should be conducted to explore to what extent the results change with the assumption made. This approach is implemented in three stages, which are described in detail: (1) descriptive analysis to inform the assumption on the missing data mechanism; (2) how to choose between alternative methods given their underlying assumptions; and (3) methods for sensitivity analysis. The case study illustrates how to apply this approach in practice, including software code. The article concludes with recommendations for practice and suggestions for future research.
authors: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK, rita.nevesdefaria@york.ac.uk.
authors: Rita
authors: R
authors: Faria
authors: Manuel
authors: M
authors: Gomes
authors: David
authors: D
authors: Epstein
authors: Ian R
authors: IR
authors: White
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D013223:Statistics as Topic / Q000592:standards*