Markov Models For Health Economic Evaluation Modelling In R With The Heemod Package

Filipović-Pierucci, Antoine; Zarca, Kevin; Durand‐Zaleski, Isabelle

doi:10.1016/j.jval.2016.09.133

Cited by 67 publications

(61 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Initial disease activity of RA is medium to high as guidelines suggest adding bDMARDs at this stage [3,8]. For calculations we used the heemod package for R [17] and Microsoft Excel.…”

Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

2020

View full text Add to dashboard Cite

Objective Recent guideline updates have suggested de-escalating DMARDs when patients with rheumatoid arthritis achieve remission or low disease activity. We aim to evaluate whether it is cost-effective to de-escalate the biological form of DMARDs (bDMARDs). Methods Using a Markov model, we performed a cost-utility analysis for RA patients on bDMARD treatment. We compared continuing treatment (standard care) to a tapering approach (i.e., an immediate 50% dose reduction), withdrawal (i.e., an immediate 100% dose reduction) and tapering followed by withdrawal of bDMARDs. The parametrization is based on a comprehensive literature review. Results were computed for 30 years with a cycle length of three months. We applied the payer's perspective for Germany and conducted deterministic and probabilistic sensitivity analyses. Results Tapering or withdrawing bDMARD treatment resulted in ICERs of €526,254 (incr. costs-78,845, incr. QALYs-0.1498) or €216,879 (incr. costs-€121,691, incr. QALYs-0.5611) compared to standard care. Tapering followed by withdrawal resulted in a loss of 0.4354 QALYs and savings of €107,969 per patient, with an ICER of €247,987. Deterministic sensitivity analysis revealed that our results remained largely unaffected by parameter changes. Probabilistic sensitivity analysis suggests that tapering, withdrawal and tapering followed by withdrawal were dominant in 39.8%, 28.2% and 29.0% of 10,000 iterations. Conclusion Our findings suggest that de-escalating bDMARDs in patients with RA may result in high cost savings but also a decrease in quality of life compared to standard care. If decision

show abstract

“…Initial disease activity of RA is medium to high as guidelines suggest adding bDMARDs at this stage [3,8]. For calculations we used the heemod package for R [17] and Microsoft Excel.…”

Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

2020

View full text Add to dashboard Cite

show abstract

“…Costs and quality-adjusted life years were discounted by 3% per year. Model calculations were conducted using the "heemod" package for R statistics [32]. The calibration of model parameters was performed with Microsoft Excel [33].…”

Section: Methodsmentioning

confidence: 99%

Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

Hofer¹,

Kauczor

Stargardt³

2018

Lung Cancer

View full text Add to dashboard Cite

Background: Lung cancer is the leading cause of cancer death in Germany. Although several randomized trials in Europe have evaluated the effectiveness of lung cancer screening programs, evidence on the cost-effectiveness of lung cancer screening is scarce. Objective: To evaluate the cost-effectiveness of a population-based lung cancer screening program from the perspective of a German payer. Methods: We conducted a cost-effectiveness analysis from the public payer perspective for a high-risk population defined as heavy former and current smokers (≥20 cigarettes per day) between 55 and 75 years of age. The underlying model consisted of two Markov models. We differentiated between a population-based annual screening program and standard clinical care. Depending on stage at diagnosis, simulated patients were assigned to one of five treatment paths according to the German clinical guideline for the diagnosis and treatment of lung cancer. Costs, life years saved, and quality adjusted life years (QALYs) were used as outcomes. Values for input parameters were taken from the literature. The model was run for 60 cycles with a cycle length of three months. Deterministic and probabilistic sensitivity analyses were conducted. Results: In the base case, annual lung cancer screening led to an increase in incremental costs (€ 1,153 per person) compared to standard clinical care. However, the screening approach was associated with an incremental gain in life years (0.06 per person) and QALYs (0.04 per person). Thus, the incremental cost-effectiveness ratio (ICER) was € 19,302 per life year saved and € 30,291 per QALY. A probabilistic sensitivity analysis with 10,000 draws resulted in average ICERs of € 22,118 per life year and € 34,841 per QALY. Conclusion: We provide evidence that lung cancer screening for a high-risk population may be more effective, but also more costly, than standard clinical care from the perspective of a German payer.

show abstract

“…The data were analysed using R software. The heemod package [28] was used to calculate the transition probabilities from annual rates, run the Markov model, calculate the incremental cost-effectiveness ratio (ICER) and perform deterministic and probabilistic sensitivity analyses. The patient-based diagnostic performances of the three imaging modalities were compared by using the Cochran Q test with McNemar chi-square as a post hoc test.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 18F-sodium fluoride PET/CT, 18F-fluorocholine PET/CT and diffusion-weighted MRI for the detection of bone metastases in recurrent prostate cancer: a cost-effectiveness analysis in France

et al. 2020

View full text Add to dashboard Cite

Background: The diagnostic performance of 18 F-sodium fluoride positron emission tomography/computed tomography (PET/CT) (NaF), 18 F-fluorocholine PET/CT (FCH) and diffusion-weighted whole-body magnetic resonance imaging (DW-MRI) in detecting bone metastases in prostate cancer (PCa) patients with first biochemical recurrence (BCR) has already been published, but their cost-effectiveness in this indication have never been compared. Methods: We performed trial-based and model-based economic evaluations. In the trial, PCa patients with first BCR after previous definitive treatment were prospectively included. Imaging readings were performed both on-site by local specialists and centrally by experts. The economic evaluation extrapolated the diagnostic performances of the imaging techniques using a combination of a decision tree and Markov model based on the natural history of PCa. The health states were non-metastatic and metastatic BCR, non-metastatic and metastatic castration-resistant prostate cancer and death. The state-transition probabilities and utilities associated with each health state were derived from the literature. Real costs were extracted from the National Cost Study of hospital costs and the social health insurance cost schedule. Results: There was no significant difference in diagnostic performance among the 3 imaging modalities in detecting bone metastases. FCH was the most cost-effective imaging modality above a threshold incremental costeffectiveness ratio of 3000€/QALY when imaging was interpreted by local specialists and 9000€/QALY when imaging was interpreted by experts. Conclusions: FCH had a better incremental effect on QALY, independent of imaging reading and should be preferred for detecting bone metastases in patients with biochemical recurrence of prostate cancer.

show abstract

Markov Models For Health Economic Evaluation Modelling In R With The Heemod Package

Cited by 67 publications

References 25 publications

Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach

Comparison of 18F-sodium fluoride PET/CT, 18F-fluorocholine PET/CT and diffusion-weighted MRI for the detection of bone metastases in recurrent prostate cancer: a cost-effectiveness analysis in France

Contact Info

Product

Resources

About