title: Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation.
abstract: Markov models have traditionally been used to evaluate the cost-effectiveness of competing health care technologies that require the description of patient pathways over extended time horizons. Discrete event simulation (DES) is a more flexible, but more complicated decision modelling technique, that can also be used to model extended time horizons. Through the application of a Markov process and a DES model to an economic evaluation comparing alternative adjuvant therapies for early breast cancer, this paper compares the respective processes and outputs of these alternative modelling techniques. DES displays increased flexibility in two broad areas, though the outputs from the two modelling techniques were similar. These results indicate that the use of DES may be beneficial only when the available data demonstrates particular characteristics.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics / Q000556:secondary; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D013629:Tamoxifen / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D013673:Technology Assessment, Biomedical / Q000191:economics*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen