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On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers

We present an overview of the main methodological features and the goals of pharmacoeconomic models that are classified in three major categories: regression models, decision trees, and Markov models. In particular, we focus on Markov models and define a semi-Markov model on the cost utility of a va...

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Detalles Bibliográficos
Autores principales: Carta, Andrea, Conversano, Claudio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661756/
https://www.ncbi.nlm.nih.gov/pubmed/33194969
http://dx.doi.org/10.3389/fpubh.2020.569500
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author Carta, Andrea
Conversano, Claudio
author_facet Carta, Andrea
Conversano, Claudio
author_sort Carta, Andrea
collection PubMed
description We present an overview of the main methodological features and the goals of pharmacoeconomic models that are classified in three major categories: regression models, decision trees, and Markov models. In particular, we focus on Markov models and define a semi-Markov model on the cost utility of a vaccine for Dengue fever discussing the key components of the model and the interpretation of its results. Next, we identify some criticalities of the decision rule arising from a possible incorrect interpretation of the model outcomes. Specifically, we focus on the difference between median and mean ICER and on handling the willingness-to-pay thresholds. We also show that the life span of the model and an incorrect hypothesis specification can lead to very different outcomes. Finally, we analyse the limit of Markov model when a large number of states is considered and focus on the implementation of tools that can bypass the lack of memory condition of Markov models. We conclude that decision makers should interpret the results of these models with extreme caution before deciding to fund any health care policy and give some recommendations about the appropriate use of these models.
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spelling pubmed-76617562020-11-13 On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers Carta, Andrea Conversano, Claudio Front Public Health Public Health We present an overview of the main methodological features and the goals of pharmacoeconomic models that are classified in three major categories: regression models, decision trees, and Markov models. In particular, we focus on Markov models and define a semi-Markov model on the cost utility of a vaccine for Dengue fever discussing the key components of the model and the interpretation of its results. Next, we identify some criticalities of the decision rule arising from a possible incorrect interpretation of the model outcomes. Specifically, we focus on the difference between median and mean ICER and on handling the willingness-to-pay thresholds. We also show that the life span of the model and an incorrect hypothesis specification can lead to very different outcomes. Finally, we analyse the limit of Markov model when a large number of states is considered and focus on the implementation of tools that can bypass the lack of memory condition of Markov models. We conclude that decision makers should interpret the results of these models with extreme caution before deciding to fund any health care policy and give some recommendations about the appropriate use of these models. Frontiers Media S.A. 2020-10-30 /pmc/articles/PMC7661756/ /pubmed/33194969 http://dx.doi.org/10.3389/fpubh.2020.569500 Text en Copyright © 2020 Carta and Conversano. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Carta, Andrea
Conversano, Claudio
On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title_full On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title_fullStr On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title_full_unstemmed On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title_short On the Use of Markov Models in Pharmacoeconomics: Pros and Cons and Implications for Policy Makers
title_sort on the use of markov models in pharmacoeconomics: pros and cons and implications for policy makers
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661756/
https://www.ncbi.nlm.nih.gov/pubmed/33194969
http://dx.doi.org/10.3389/fpubh.2020.569500
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