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Identifying Topics For Model-Based Economic Evaluation

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Muhammad ilyas Apoteker
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9 views

Identifying Topics For Model-Based Economic Evaluation

Uploaded by

Muhammad ilyas Apoteker
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Identifying topics for model-based

economic evaluation

Auliya A. Suwantika

Center of Excellence for Pharmaceutical Care Innovation (PHARCI)


Universitas Padjadjaran
Offline meetings
1 Pendahuluan
2 Model-based Pharmacoeconomics
3 Identifikasi Topik untuk Studi Modelling Farmakoekonomi
4 Decision Tree Model
5 Simulasi Decision Tree Model
6 Markov Model
7 Simulasi Markov Model
UTS (project-based)
8 Dynamic Model
9 Cost-Effectiveness Acceptability Curve
10 Univariate Sensitivity Analysis
11 Probabilistic Sensitivity Analysis
12 Studi Kasus 1 (Penyakit Psikiatri, Gastrologi, Obstetri dan Ginekologi)
13 Studi Kasus 2 (Penyakit Sistem Saraf, Endokrin, Jantung, Ginjal dan Pembuluh Darah)
14 Studi Kasus 3 (Penyakit Onkologi, Infeksi, Sistem Pernafasan dan Imunologi)
UAS (project-based)
Learning objectives

• To understand why model-based economic evaluation is


necessary
• To understand the pros and cons of various decision models in
economic evaluation and when they are most suited for use
• To identify topics for model-based economic evaluation
What is model-based economic evaluation?

• Synthesize evidence and assumptions from multiple sources to


estimate the long-term incremental costs and outcomes of new
therapies
• Allows all relevant comparators to be simultaneously evaluated
• Transparency on model structure, data and assumptions is
critical
Why do we need model-based economic evaluation?

• Data required to fully evaluate the costs and benefits of an


intervention may not be available in a single study
• Observation period in clinical trials tend to be short, e.g.
several weeks to several months to 1 to 2 years
Types of decision analytic models

• Static model
• Decision tree
• Markov model
• Decision tree + Markov model
• Dynamic model
Modeling Good Research Practices

• Conceptualizing a Model
• State-Transition Modeling
• Modeling using Discrete Event Simulation
• Dynamic Transmission Modeling
• Model Parameter Estimation and Uncertainty Analysis
• Model Transparency and Validation
Brennan A, Chick SE, Davies R. A taxonomy of model structures for economic evaluation of health technologies. Health Econ. 2006;15(12):1295-1310.
Many different types of models for a single disease

https://jheor.org/article/9831-how-do-diabetes-models-measure-up-a-review-of-diabetes-economic-models-and-ada-guidelines
Many different types of models for a single disease

https://jheor.org/article/9831-how-do-diabetes-models-measure-up-a-review-of-diabetes-economic-models-and-ada-guidelines
Decision tree model
• Simple
• Suitable for relatively uncomplicated scenarios or events that
happen over a short time horizon

NGT – Normal Glucose Tolerance


IGT – Impaired Glucose Tolerance
T2DM –Type 2 Diabetes Mellitus
Neumann A, et al. Cost Effectiveness and Resource Allocation 2011;9:17
Markov model

• Events are modeled as transition from one health state to


another (e.g. NGT à IGT)
• Each cycle has a fixed length, e.g. one year
• At the end of each cycle, a proportion of patients
• Move out of the health state to another health state (e.g. NGT à IGT)
• Remains in the same health state (e.g. NGT à NGT)
Markov cohort model

Neumann A, et al. Cost Effectiveness and Resource Allocation 2011;9:17


Transition probabilities

• No intervention
• Transition probability (NGT à IGT) x N = 0.163 x 1000 = 163
• N = number of individuals with NGT
• With intervention
• Transition probability (NGT à IGT) x N = 0.152 x 1000 = 152
• Fewer individuals will develop IGT (i.e. intervention is effective)
Neumann A, et al. Cost Effectiveness and Resource Allocation 2011;9:17
Markov cohort model

• Patients are modeled as a cohort with identical attributes


• e.g. individuals with a Finnish Type 2 Diabetes Risk Score 11-20 (the FINDRISC) (i.e. high risk
of developing diabetes).
• Suitable for events that are time-dependent
• e.g. development of diabetes complications, gout controlled and controlled, cancer
progression, atrial fibrillation, etc.

Ref. Ann Intern Med. 2014;161(9):617-626.


Markov cohort model

• Number of cycles depend on the time horizon of the analysis


• 5 years, 10 years, lifetime or until 99.9% of the cohort dies
• Transition is dependent on conditional probabilities, which may
vary over time
• An individual in the T2DM state could have take either of the
following pathways:
• NGT à IGT à T2DM
• NGT à IGT à NGT à IGT à T2DM
Markov cohort model

• Cost and outcomes (e.g. QALY) are attached to each health state
• Total costs = cost associated with each health state X number of patients who experienced the
health state X duration that patient is in the health state and then summing across all states
experienced in the model
How to identify topics for model-based economic evaluation

https://www.pcori.org/get-involved/suggest-patient-centered-research-question/how-write-practical-useful-research-question
The People
• Who are the people that should be studied? This is the population of
interest.
• The people to be studied may be identified in different ways.
o People living with a specific condition, OR

o People who are at risk for a specific condition, OR

o Caregivers for people with a specific condition

• Examples:
o All people with low back pain

o Injection drug users who share needles and are at risk for Hepatitis C

o Parents of teenagers with mental illness


The Options
• What options should be compared? These are the decisions the
research is intended to inform.
• Options that should be compared may be:
o One or more tests or treatments for a specific condition, OR
o One or more ways to deliver the care for the specific condition, OR
o Choosing among different ways to inform people about the benefits
and harms of different choices.
The Outcomes

• How can people make informed choices between options?


• These are the factors that people will consider when making a
decision between their options.
• This may be:
o Identifying which treatment or test option has the most benefits
and the least harms for the population of interest, OR
o Identifying which form of healthcare delivery is most likely to
produce a specific benefit such as improved pain control.
What factors determine if a research question becomes a study?

• The outcomes are relevant to patients and caregivers.


• The research provides new knowledge or fills in gaps in our current
knowledge.
• The research focuses on conditions that have the greatest impact on
the most people.
• The research findings are likely to be used by clinicians and/or health
care systems.
Economic evaluation toolkit
Cost Cost Cost Cost
minimization benefit effectiveness utility
analysis analysis analysis analysis

Compare the
Compare the Compare the dollar
Calculate the dollar costs of 2 or
dollar costs and costs of 2 or more
dollar costs of a more interventions
and benefits (in interventions with
condition or with a common
terms of averted different health
intervention(s) health outcome
costs) outcomes

Is this the best


Can it sustain Is this the most way to improve
How much is itself from a efficient way to overall health
this costing / will improve my and well-being
budget
this cost me? perspective? target clinical within the
outcomes? healthcare
system?
Analyzing problems and programs

Cost Cost Cost Cost


minimization benefit effectiveness utility
analysis analysis analysis analysis

$C $B / $C ΔC / ΔE ΔC / ΔQALY

Which approach Which approach


How much is this Is it worth gives the best gives the best
problem or investing in this value in terms of value in terms of
intervention or not? improving my overall welfare
costing me? target indicator? gain?
Can you identify the People, Options and
Outcomes from these following studies?
Suwantika AA, Supadmi W, Ali M, Abdulah R. Cost-effectiveness and budget impact analyses of dengue vaccination in Indonesia. PLoS Negl Trop Dis. 2021 Aug 12;15(8):e0009664.
Suwantika AA, Supadmi W, Ali M, Abdulah R. Cost-effectiveness and budget impact analyses of dengue vaccination in Indonesia. PLoS Negl Trop Dis. 2021 Aug 12;15(8):e0009664.
Suwantika AA, Supadmi W, Ali M, Abdulah R. Cost-effectiveness and budget impact analyses of dengue vaccination in Indonesia. PLoS Negl Trop Dis. 2021 Aug 12;15(8):e0009664.
Suwantika AA, Dhamanti I, Suharto Y, Purba FD, Abdulah R. The cost-effectiveness of social distancing measures for mitigating the COVID-19 pandemic in a highly-populated country:
A case study in Indonesia. Travel Med Infect Dis. 2022 Jan-Feb;45:102245.
Suwantika AA, Dhamanti I, Suharto Y, Purba FD, Abdulah R. The cost-effectiveness of social distancing measures for mitigating the
COVID-19 pandemic in a highly-populated country: A case study in Indonesia. Travel Med Infect Dis. 2022 Jan-Feb;45:102245.
Suwantika AA, Dhamanti I, Suharto Y, Purba FD, Abdulah R. The cost-effectiveness of social distancing measures for mitigating the
COVID-19 pandemic in a highly-populated country: A case study in Indonesia. Travel Med Infect Dis. 2022 Jan-Feb;45:102245.
Zakiyah N, Sinuraya RK, Kusuma ASW, Suwantika AA, Lestari K. Cost-Effectiveness Analysis of Sacubitril/Valsartan
Compared to Enalapril for Heart Failure Patients in Indonesia. Clinicoecon Outcomes Res. 2021 Oct 5;13:863-872.
Zakiyah N, Sinuraya RK, Kusuma ASW, Suwantika AA, Lestari K. Cost-Effectiveness Analysis of Sacubitril/Valsartan
Compared to Enalapril for Heart Failure Patients in Indonesia. Clinicoecon Outcomes Res. 2021 Oct 5;13:863-872.
Zakiyah N, Sinuraya RK, Kusuma ASW, Suwantika AA, Lestari K. Cost-Effectiveness Analysis of Sacubitril/Valsartan
Compared to Enalapril for Heart Failure Patients in Indonesia. Clinicoecon Outcomes Res. 2021 Oct 5;13:863-872.
Terima kasih

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