We have located links that may give you full text access.
An Investigation into the Relationship Between Choice of Model Structure and How to Adjust for Subsequent Therapies Using a Case Study in Oncology.
Applied Health Economics and Health Policy 2023 Februrary 28
BACKGROUND: A common challenge in health technology assessments (HTAs) of cancer treatments is how subsequent therapy use within the trial follow-up may influence cost-effectiveness model outcomes. Although overall survival (OS) is often a key driver of model results, there are no guidelines to advise how to adjust for this potential confounding, with different approaches available dependent on the model structure.
OBJECTIVE: We compared a partitioned survival analysis (PartSA) with a semi-Markov multi-state model (MSM) structure, with and without attempts to adjust for the impact of subsequent therapies on OS using a case study describing outcomes for people with relapsed/refractory multiple myeloma.
METHODS: Both model structures included three health states: pre-progression, progressed disease and death. Three traditional crossover methods were considered within the context of the PartSA, whereas for the MSM, the probability of post-progression death was pooled across arms. Impacts on the model incremental cost-effectiveness ratio (ICER) were recorded.
RESULTS: The unadjusted PartSA produced an ICER of £623,563, and after adjustment yielded an ICER range of £381,340-£386,907. The unadjusted MSM produced an ICER of £1,283,780. Adjusting OS in the MSM resulted in an ICER of £345,486.
CONCLUSIONS: The simplicity of the PartSA is lost when the decision problem becomes more complex (for example, when OS data are confounded by subsequent therapies). In this setting, the MSM structure may be considered more flexible, with fewer and less restrictive assumptions required versus the PartSA. Researchers should consider important study design features that may influence the generalisability of data when undertaking model conceptualisation.
OBJECTIVE: We compared a partitioned survival analysis (PartSA) with a semi-Markov multi-state model (MSM) structure, with and without attempts to adjust for the impact of subsequent therapies on OS using a case study describing outcomes for people with relapsed/refractory multiple myeloma.
METHODS: Both model structures included three health states: pre-progression, progressed disease and death. Three traditional crossover methods were considered within the context of the PartSA, whereas for the MSM, the probability of post-progression death was pooled across arms. Impacts on the model incremental cost-effectiveness ratio (ICER) were recorded.
RESULTS: The unadjusted PartSA produced an ICER of £623,563, and after adjustment yielded an ICER range of £381,340-£386,907. The unadjusted MSM produced an ICER of £1,283,780. Adjusting OS in the MSM resulted in an ICER of £345,486.
CONCLUSIONS: The simplicity of the PartSA is lost when the decision problem becomes more complex (for example, when OS data are confounded by subsequent therapies). In this setting, the MSM structure may be considered more flexible, with fewer and less restrictive assumptions required versus the PartSA. Researchers should consider important study design features that may influence the generalisability of data when undertaking model conceptualisation.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app