Comprehensive decision analytical modelling in economic evaluation: a Bayesian approach.
Decision analytical models are widely used in economic evaluation of health care interventions with the objective of generating valuable information to assist health policy decision-makers to allocate scarce health care resources efficiently. The whole decision modelling process can be summarised in four stages: (i) a systematic review of the relevant data (including meta-analyses), (ii) estimation of all inputs into the model (including effectiveness, transition probabilities and costs), (iii) sensitivity analysis for data and model specifications, and (iv) evaluation of the model. The aim of this paper is to demonstrate how the individual components of decision modelling, outlined above, may be addressed simultaneously in one coherent Bayesian model (sometimes known as a comprehensive decision analytical model) and evaluated using Markov Chain Monte Carlo simulation implemented in the specialist software WinBUGS. To illustrate the method described, it is applied to two illustrative examples: (1) The prophylactic use of neurominidase inhibitors for the prevention of influenza. (2) The use of taxanes for the second-line treatment of advanced breast cancer. The advantages of integrating the four stages outlined into one comprehensive decision analytical model, compared to the conventional 'two-stage' approach, are discussed.
Cooper
Nicola J
NJ
Department of Epidemiology and Public Health, University of Leicester, UK. njc21@le.ac.uk
Sutton
Alex J
AJ
Abrams
Keith R
KR
Turner
David
D
Wailoo
Allan
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D001499:Bayes Theorem; D001943:Breast Neoplasms / Q000188:drug therapy; D000077143:Docetaxel; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D015276:Health Care Rationing; D005102:Health Expenditures; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy / Q000201:enzymology; D008875:Middle Aged; D018803:Models, Economic; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use; D006113:United Kingdom
D000972:Antineoplastic Agents, Phytogenic; D004791:Enzyme Inhibitors; D043823:Taxoids; D000077143:Docetaxel; D009439:Neuraminidase