Introduction To Modelling Sutton
Introduction To Modelling Sutton
decision modelling
Andrew Sutton
Learning objectives
Understand:
• the role of modelling in economic evaluation
• the construction and analysis of decision trees
• the design and interpretation of a simple
Markov model
• the appropriate circumstances for their use
Role of modelling in economic evaluation
• Extrapolate costs and effectiveness beyond trial data
• Reflect all appropriate evidence
• Compare all relevant options
• Link intermediate clinical endpoints to final outcomes
• Generalise results obtained in one clinical setting to
other settings
• Inform resource allocation decisions in the absence of
“hard data”
• Make head-to-head comparisons of alternative
competing interventions when relevant trials do not
exist
The main types of model
• Decision trees
• Markov models
• Outcomes include:
– Total cost
– Total utilities
– Life years (LY)
– Quality-adjusted life years (QALYs)
• Utilities assumed
– DVT – 0.70
– Bleed – 0.95
– DVT & bleed – 0.65
– No event – 1.00
Entering outcomes (QALYs) QALY
Bleed
0.65
DVT 0.1
0.14 No bleed
0.7
L MW heparin 0.9
Bleed
0.95
No DVT 0.1
0.86 No bleed
1.00
Hip replacement patients 0.9
Bleed
0.65
DVT 0.01
0.25 No bleed
0.7
Conventional treatment 0.99
Bleed
0.95
No DVT 0.01
0.75 No bleed
1.00
0.99
WELL ILL
DEAD
Elements of Markov models
• Markov states should be mutually exclusive and
exhaustive
• Transition probabilities
– Transition from one state to another at end of a single cycle
– Fixed transition probabilities out of each state, adding up to 1
• Markov rewards
– Values assigned to each health state that represent the cost
and utility of spending one cycle in that state
Simple Markov model
0.97
0.9
WELL ILL
0.02
0.1
0.01
DEAD 1.0
Steps in constructing a Markov model
1. Define states and allowable transitions
2. Choose a cycle length
3. Specify a set of transition probabilities between
states
4. Assign a cost and utility to each health state
5. Identify the initial distribution of the population
6. Methods of evaluation
Markov model: Simple example
• Stroke prevention model
– Atrial fibrillation is a chronic heart arrhythmia which
increases the risk of stroke (ischaemic)
– Therapy available to reduce the risk of stroke - e.g.
warfarin
– Disabling stroke incurs costs over a long period of time
and reduces quality of life
– A Markov model is designed to evaluate the cost-
effectiveness of treatments to prevent stroke in AF
– Following example will concentrate on model structure
Markov states
P11 P22
P12
WELL, AF STROKE
P13 P33
P23
DEAD
Decide on a cycle length
Transitions From
Well (1) Stroke (2) Dead (3)
time t to time t+1
P11
Well (1) P12=0.07 P13=0.01
(=1-P12-P13=0.92)
P22
Stroke (2) 0 P23=0.25
(=1-P23=0.75)
Dead (3) 0 0 1
Attach costs and utilities to states
Death 0 0
Define initial distribution of population