PRACTICAL APPLICATION A Guide to Handling Missing Data in Cost-Effectiveness Analysis Conducted Within Randomised Controlled Trials

The Author(s) 2014. This article is published with open access at Springerlink.com Abstract Missing data are a frequent problem in cost-effectiveness analysis (CEA) within a randomised con-trolled 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) descrip-tive 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. Key Points for Decision Makers Missing data are a frequent problem in cost-effectiveness analysis within a randomised clinical trial. Different methods of handling missing data can yield different results and affect decisions on the value for money of healthcare interventions. The choice of method should be grounded in the assumed missing data mechanism, which in turn should be informed by the available evidence. The impact of alternative assumptions about the missing data mechanism should be carefully assessed in sensitivity analysis.