ArticleJournal of rehabilitation medicine2025
A cost-utility analysis for return-to-work interventions comparing alternative methods for handling missing health-related quality of life data.
Article in Journal of rehabilitation medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectivePerform a cost-utility analysis for return-to-work interventions with missing health-related quality-of-life (HRQoL) data while transparently demonstrating the impact of different methods of handling missing data on outcomes.
methodsThe costs and quality-adjusted life-years over a 2-year period were estimated for 2 return-to-work interventions, inpatient multimodal occupational rehabilitation (I-MORE) and outpatient acceptance and commitment therapy (O-ACT), using a healthcare perspective and a limited societal perspective. Four methods were used to handle the missing HRQoL data: complete case analysis, single imputation, multiple imputation, and linear mixed models. The cost-effectiveness outcomes were expressed as incremental net monetary benefit.
resultsThe average incremental quality-adjusted life-years comparing I-MORE with O-ACT ranged between -0.001 and 0.330 depending on missingness method. From a healthcare perspective, I-MORE was consistently not cost-effective (incremental net monetary benefits ranged from -€7,094 to -€9,363) while from a limited societal perspective, I-MORE was consistently cost-effective (incremental net monetary benefits ranged from €1,293 to €16,277).
conclusionWhile cost-effectiveness findings remained consistent within each analytical perspective, the choice of different missingness methods led to variations in incremental quality-adjusted life-years. Multiple imputation is recommended to handle missing HRQoL data as it is transparent and flexible. How-ever, a thorough investigation of the missing data mechanism should still be conducted.
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