CaseStudy_MarkovProg

NoneIntroduction and Learning Objectives

By the end of this session, participants will be able to:

1.Expand Markov models building on the simple model to add complexity 2. Model disease-specific mortality by distinguishing disease deaths from all-cause mortality 3. Implement one-time transition costs 4. Evaluate progression’s impact on CEA and understand how this complexity changes cost-effectiveness results

To help visualize how this will work, here is a bubble diagram

Adding in progression in our model can help create a more realistic clinical model.

Previously we assumed that everyone with Disease X received palliative care but in clinical reality it is only provided with progressed disease. There is also a one time cost for a higher dose of palliative care when transitioning from mild to progressive disease.

While treatment lowers your probability of Healthy to Sick, it does not affect the probability of disease progression (Sick to Sicker). We will assume that no one starts in progressed disease. Disease death can only happen from the progressed state. The % of deaths from Disease X is minimal in the total death rate so there is no need to remove it from the all cause deaths.

Additional Parameters

Name Value Description
p_sicker 0.12 Annual probability of getting sicker from a mild case of Disease X
c_mild $1,000 Cost of being mildly sick (doctors appointments)
c_initialsicker $50,000 One-time cost between mild and progression

Add the additional states to your model

Disease Death

Add a “Disease Death” state

More assistance with step

  1. Create a “Disease Death” state from the markov node
  2. Set the starting probability to 0
  3. Create a return to “Disease Death” event

Check your Model

Sicker

Add a “Sicker” state

More assistance with step

A: Create a Sicker State

  1. Add a Sicker state to the “Treat None” markov model

  2. Set the starting probability to 0

  3. Add all cause death event

  4. Add disease death event

  5. Update outcomes and probabilities

B: Update the Sick State

  1. Update Sick to go to Sicker
  2. Add one time cost of sick to sicker
  3. Set cost of the Sick state to c_mild

To find where a variable is in a model use the “Highlight Use” Tool

  1. Select the Expression of a parameter or variable that you want to find in the model
  2. Click the symbol above at the top of the right sidebar

Now the variable will highlight green everywhere it is in the model.

Check your Model

Repeat for the markov models on Treat ALL

Check your Model

TipCheck your answer


Enter the ICER for the strategy you would choose (to 2 deminal places)


Screening Added

Amua File With Screening Added