A Bayesian framework for health economic evaluation in studies with missing data.

A Bayesian framework for health economic evaluation in studies with missing data.
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DOI:
10.1002/hec.3793
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发表时间:
2018-11
期刊:
影响因子:
2.1
通讯作者:
Carpenter JR
Carpenter JR
中科院分区:
医学3区
文献类型:
--
作者:
Mason AJ;Gomes M;Grieve R;Carpenter JR

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缺失数据的卫生经济学研究越来越多地使用多重插补等方法,这些方法假设数据是“随机缺失”的。这种假设通常是有问题的,因为即使给出了观察到的数据,数据缺失的概率也可能反映了真实的、未观察到的结果,例如患者的真实健康状况。在这些情况下,方法指南建议进行敏感性分析,以识别数据可能是“非随机缺失”(MNAR),并呼吁开发实用的、可访问的方法,以探索MNAR假设结论的稳健性。很少有人注意到数据在卫生经济学中可能是MNAR的问题,特别是在成本效益分析(CEA)中。在本文中,我们提出了一个贝叶斯框架CEA的结果或成本数据丢失。我们的框架包括一个实用的,可访问的敏感性分析方法,允许分析师借鉴专家意见。我们在CEA中比较了腹主动脉瘤破裂患者的血管内策略与开放式修复术,并提供了实施这种方法的软件工具。
Health economics studies with missing data are increasingly using approaches such as multiple imputation that assume that the data are “missing at random.” This assumption is often questionable, as—even given the observed data—the probability that data are missing may reflect the true, unobserved outcomes, such as the patients' true health status. In these cases, methodological guidelines recommend sensitivity analyses to recognise data may be “missing not at random” (MNAR), and call for the development of practical, accessible approaches for exploring the robustness of conclusions to MNAR assumptions. Little attention has been paid to the problem that data may be MNAR in health economics in general and in cost‐effectiveness analyses (CEA) in particular. In this paper, we propose a Bayesian framework for CEA where outcome or cost data are missing. Our framework includes a practical, accessible approach to sensitivity analysis that allows the analyst to draw on expert opinion. We illustrate the framework in a CEA comparing an endovascular strategy with open repair for patients with ruptured abdominal aortic aneurysm, and provide software tools to implement this approach.
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