Less is More: Imputing for Missing Direct Medical Costs within the Middle East and North Africa Region Using Macroeconomic Indicators

The Middle East and North Africa region (MENA) is suffering from a scarcity of economic data which slows the implementation of health economic analysis when deciding on local health policies. Transferring costs from other jurisdictions may help to overcome this issue, yet there is no evidence of whether it can be an appropriate solution in the MENA context. A systematic review of disease-related costs from MENA analyzed their transferability and estimated a cost transfer formula adjusting for gross domestic product (GDP) per capita using available costs which applied the same reporting methods for the same costing year. The aim of this paper was to extend the GDP per capita formula incorporating macroeconomic indicators related to health expenditure. We used the same dataset of 148 direct medical costs from eight multicounty studies. As total health expenditure (THE) per capita and governmental health expenditure (GHE) per capita might not be always available for all countries, we imputed for missing data using the mean of GDP per capita and THE per capita or GHE per capita and run a robust regression using three prediction models combining the geometric mean combination of the three indicators. The results showed that adjusting the average of available foreign costs by 0.28 times the relative difference in GDP per capita still the best estimation technique. Further research is needed to explain the barriers to use transferability and to establish MENA region-specific transferability guidelines.