title: Core discrete event simulation model for the evaluation of health care technologies in major depressive disorder.
abstract: OBJECTIVE
  A review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies.
  
  
  METHODS
  This model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source.
  
  
  RESULTS
  Predicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years.
  
  
  CONCLUSIONS
  The discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD.
authors.affiliation: Creativ-Ceutical, Paris, France. Electronic address: ava@creativ-ceutical.com.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Vataire
authors.affiliation: Creativ-Ceutical, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aballéa
authors.affiliation: University of La Rioja, Logrono, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Antonanzas
authors.affiliation: Erasmus University Rotterdam, Rotterdam, The Netherlands.
authors.forename: Leona Hakkaart-van
authors.initials: LH
authors.lastname: Roijen
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.affiliation: King's College, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: The Swedish Institute for Health Economics, Lund, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Persson
authors.affiliation: University of Lyon, Lyon, France.
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D020811:Biomedical Technology / Q000191:economics*; D003198:Computer Simulation; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D010820:Physicians / Q000191:economics; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000379:methods; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; cost-effectiveness; depression; discrete event simulation