Comparing the Cohort and Micro-Simulation Modeling Approaches in Cost-Effectiveness Modeling of Type 2 Diabetes Mellitus: A Case Study of the IHE Diabetes Cohort Model and the Economics and Health Outcomes Model of T2DM

Willis, Michael; Fridhammar, Adam; Gundgaard, Jens; Nilsson, Andreas; Johansen, Pierre

doi:10.1007/s40273-020-00922-6

Cited by 18 publications

(24 citation statements)

References 41 publications

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“…There are however, important advantages of using the microsimulation model that offset this limitation. For example, recent evidence from a comparison of diabetes’ models suggests that microsimulation models provide less biased estimates of the ICER, despite their lack of flexibility to explore issues such as parameter uncertainty [ 33 ]. Ideally, a model would be able to achieve both unbiased ICER estimation and provide a comprehensive exploration of parameter uncertainty.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

et al. 2021

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Objectives To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases. Methods An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results. Results RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption. Conclusions RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

et al. 2021

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“…The most commonly used model in health is the cohort‐based model, which assumes that each individual in the cohort has the same disease progression, so group means are used to determine individual transition from one health state to another. Cohort‐based models produce uniform estimates and smaller range of cost‐effectiveness outputs, 24 which could restrict the generalization of results, particularly when the sample size is small. Hence, a microsimulation technique was used.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Tonmukayakul

Forrest²,

Arrow³

2021

Australian Dental Journal

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Background This study assessed the cost‐effectiveness of atraumatic restorative treatment and the Hall Technique approach (ART/HT) in managing dental caries in young children under the health provider perspective in order to explore a best‐buy alternative to dental general anaesthesia (DGA). Methods Sixty‐five observations from a randomized controlled trial were used to construct 20 000 microsimulations representing individual‐level clinical outcome and costs of the DGA and ART/HT. Outcome was percentage of successfully managed cases. Costs were reported in 2020 price. Three different scenarios with different assumptions of clinical success of the DGA and the ART/HT were analysed. Probabilistic sensitivity analysis was carried out. Results The ART/HT successfully managed more cases at lower cost ($557) than the DGA when the system failure of the DGA was considered. Under per protocol analysis, participants in both arms were successfully managed, but the ART/HT costed $580 less than the DGA. Probabilistic sensitivity analysis confirmed the ART/HT was a dominant intervention. Conclusions The ART/HT approach was non‐inferior in managing dental caries in young children but at lower costs than the DGA. The ART/HT could be a viable option in the provision of comprehensive dental care in locations with limited access to DGA and reduce hospital admission.

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“…Furthermore, in the eventuality of limited data, DES models also provide a substantial advantage, because the inadequacy of the data is not built into the structure of the model; the simulation can be designed to properly reflect the problem under analysis and perform exploratory analyses with limited data and bestguess estimates. [42][43][44][45] Therefore, although there is a need of a detailed and comprehensive database for estimating the regression equations governing the time-to-event calculations, after the development and validation of the model, which was the goal of our study, it is possible to test a wide variety of scenarios and perform subgroup analyses by changing the settings of the model and the simulated model population.…”

Section: Discussionmentioning

confidence: 99%

Modeling Early Warning Systems: Construction and Validation of a Discrete Event Simulation Model for Heart Failure

et al. 2021

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Developing and validating a discrete event simulation model that is able to model patients with heart failure managed with usual care or an early warning system (with or without a diagnostic algorithm) and to account for the impact of individual patient characteristics in their health outcomes. Methods:The model was developed using patient-level data from the Trans-European Network -Home-Care Management System study. It was coded using RStudio Version 1.3.1093 (version 3.6.2.) and validated along the lines of the Assessment of the Validation Status of Health-Economic decision models tool. The model includes 20 patient and disease characteristics and generates 8 different outcomes. Model outcomes were generated for the base-case analysis and used in the model validation.Results: Patients managed with the early warning system, compared with usual care, experienced an average increase of 2.99 outpatient visits and a decrease of 0.02 hospitalizations per year, with a gain of 0.81 life years (0.45 quality-adjusted life years) and increased average total costs of V11 249. Adding a diagnostic algorithm to the early warning system resulted in a 0.92 life year gain (0.57 quality-adjusted life years) and increased average costs of V9680. These patients experienced a decrease of 0.02 outpatient visits and 0.65 hospitalizations per year, while they avoided being hospitalized 0.93 times. The model showed robustness and validity of generated outcomes when comparing them with other models addressing the same problem and with external data.Conclusions: This study developed and validated a unique patient-level simulation model that can be used for simulating a wide range of outcomes for different patient subgroups and treatment scenarios. It provides useful information for guiding research and for developing new treatment options by showing the hypothetical impact of these interventions on a large number of important heart failure outcomes.

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Comparing the Cohort and Micro-Simulation Modeling Approaches in Cost-Effectiveness Modeling of Type 2 Diabetes Mellitus: A Case Study of the IHE Diabetes Cohort Model and the Economics and Health Outcomes Model of T2DM

Cited by 18 publications

References 41 publications

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Modeling Early Warning Systems: Construction and Validation of a Discrete Event Simulation Model for Heart Failure

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