title: Challenges in modelling the cost effectiveness of various interventions for cardiovascular disease.
abstract: OBJECTIVE
  Decision analytic modelling is essential in performing cost-effectiveness analyses (CEAs) of interventions in cardiovascular disease (CVD). However, modelling inherently poses challenges that need to be dealt with since models always represent a simplification of reality. The aim of this study was to identify and explore the challenges in modelling CVD interventions.
  
  
  METHODS
  A document analysis was performed of 40 model-based CEAs of CVD interventions published in high-impact journals. We analysed the systematically selected papers to identify challenges per type of intervention (test, non-drug, drug, disease management programme, and public health intervention), and a questionnaire was sent to the corresponding authors to obtain a more thorough overview. Ideas for possible solutions for the challenges were based on the papers, responses, modelling guidelines, and other sources.
  
  
  RESULTS
  The systematic literature search identified 1,720 potentially relevant articles. Forty authors were identified after screening the most recent 294 papers. Besides the challenge of lack of data, the challenges encountered in the review suggest that it was difficult to obtain a sufficiently valid and accurate cost-effectiveness estimate, mainly due to lack of data or extrapolating from intermediate outcomes. Despite the low response rate of the questionnaire, it confirmed our results.
  
  
  CONCLUSIONS
  This combination of a review and a survey showed examples of CVD modelling challenges found in studies published in high-impact journals. Modelling guidelines do not provide sufficient guidance in resolving all challenges. Some of the reported challenges are specific to the type of intervention and disease, while some are independent of intervention and disease.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands, burgers@bmg.eur.nl.
authors.forename: Laura T
authors.initials: LT
authors.lastname: Burgers
authors.forename: William K
authors.initials: WK
authors.lastname: Redekop
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome
references.citation: Epidemiology. 2009 Jul;20(4):555-61
references.pmid: 19367167
references.citation: Circulation. 2010 Mar 23;121(11):1329-37
references.pmid: 20212277
references.citation: Pharmacoeconomics. 2000 May;17(5):479-500
references.pmid: 10977389
references.citation: Stat Med. 2003 Dec 15;22(23):3687-709
references.pmid: 14652869
references.citation: Value Health. 2012 Sep-Oct;15(6):821-7
references.pmid: 22999131
references.citation: Value Health. 2012 Sep-Oct;15(6):804-11
references.pmid: 22999129
references.citation: Med Decis Making. 2013 Jul;33(5):671-8
references.pmid: 23804510
references.citation: Stat Med. 2007 May 20;26(11):2389-430
references.pmid: 17031868
references.citation: Value Health. 2009 Jun;12(4):404-6
references.pmid: 19138305
references.citation: Value Health. 2012 Sep-Oct;15(6):812-20
references.pmid: 22999130
references.citation: Med Decis Making. 2013 Jul;33(5):657-70
references.pmid: 23804509
references.citation: Value Health. 2007 Nov-Dec;10(6):498-509
references.pmid: 17970932
references.citation: Am J Cardiol. 1984 Jul 1;54(1):43-9
references.pmid: 6741837
references.citation: Appl Health Econ Health Policy. 2013 Feb;11(1):15-26
references.pmid: 23329383
references.citation: Pharmacoeconomics. 2008;26(2):131-48
references.pmid: 18198933
references.citation: Med Decis Making. 2013 Jul;33(5):618-40
references.pmid: 23804507
references.citation: Value Health. 2012 Sep-Oct;15(6):835-42
references.pmid: 22999133
references.citation: Am Heart J. 1991 Jan;121(1 Pt 2):293-8
references.pmid: 1985385
references.citation: Value Health. 2012 Sep-Oct;15(6):796-803
references.pmid: 22999128
references.citation: Pharmacoeconomics. 1996 Nov;10(5):460-6
references.pmid: 10172868
references.citation: Med Care. 2005 Jun;43(6):521-30
references.pmid: 15908846
references.citation: Value Health. 2013 Sep-Oct;16(6):1100-2
references.pmid: 24041361
references.citation: Health Technol Assess. 2005 Jul;9(27):iii-iv, ix-xi, 1-158
references.pmid: 16022802
references.citation: Med Decis Making. 2013 Jul;33(5):641-56
references.pmid: 23804508
references.citation: Med Decis Making. 2013 Jul;33(5):679-91
references.pmid: 23804511
references.citation: Health Technol Assess. 2012;16(9):1-218
references.pmid: 22381040
references.citation: BMJ. 2006 Dec 2;333(7579):1145
references.pmid: 17098764
references.citation: Value Health. 2010 Jun-Jul;13(4):501-6
references.pmid: 20345550
references.citation: Pharmacoeconomics. 2013 Feb;31(2):111-23
references.pmid: 23329430
references.citation: Med Decis Making. 2013 Jul;33(5):607-17
references.pmid: 23104435
references.citation: Pharmacoeconomics. 2006;24(11):1043-53
references.pmid: 17067190
references.citation: Med Decis Making. 2012 May-Jun;32(3):507-16
references.pmid: 22472915
references.citation: Lancet. 2007 Sep 15;370(9591):937-48
references.pmid: 17869634
references.citation: Radiology. 2013 May;267(2):387-95
references.pmid: 23392425
references.citation: Am Heart J. 2005 Mar;149(3):434-43
references.pmid: 15864231
references.citation: Pharmacoeconomics. 2013 May;31(5):361-7
references.pmid: 23529207
references.citation: Value Health. 2012 Sep-Oct;15(6):828-34
references.pmid: 22999132
references.citation: Health Econ. 2003 May;12(5):377-92
references.pmid: 12720255
references.citation: Health Serv Res. 1992 Jun;27(2):219-38
references.pmid: 1592606
references.citation: Stat Methods Med Res. 2000 Oct;9(5):421-45
references.pmid: 11191259
references.citation: Eur Heart J. 2003 Jun;24(11):987-1003
references.pmid: 12788299
references.citation: Value Health. 2007 Jan-Feb;10(1):3-12
references.pmid: 17261111
references.citation: BMJ Open. 2011 Dec 21;1(2):e000363
references.pmid: 22189351
references.citation: Value Health. 2010 Aug;13(5):509-18
references.pmid: 20230546
references.citation: Health Technol Assess. 2000;4(35):1-117
references.pmid: 11109031
references.citation: Value Health. 2012 Sep-Oct;15(6):843-50
references.pmid: 22999134
references.citation: Pediatrics. 1999 Apr;103(4):e54
references.pmid: 10103346
references.citation: Med Decis Making. 2013 Jul;33(5):597-606
references.pmid: 23804506
references.citation: Health Technol Assess. 2001;5(12):1-79
references.pmid: 11319991
references.citation: Value Health. 2011 Jan;14(1):53-60
references.pmid: 21211486
references.citation: Health Technol Assess. 2004 Oct;8(38):iii-iv, 1-196
references.pmid: 15461876
references.citation: J Am Coll Cardiol. 2011 Oct 11;58(16):1690-701
references.pmid: 21982314
references.citation: Health Technol Assess. 2004 Sep;8(35):iii-iv, 1-242
references.pmid: 15361315
references.citation: J Am Coll Cardiol. 1997 Dec;30(7):1741-50
references.pmid: 9385902
references.citation: Circulation. 2013 Feb 19;127(7):820-31
references.pmid: 23277307
references.citation: Value Health. 2009 Jun;12(4):402-4
references.pmid: 19138306
references.citation: Am J Cardiol. 1983 Feb;51(3):449-54
references.pmid: 6401909
references.citation: Value Health. 2012 Jan;15(1):94-105
references.pmid: 22264977
references.citation: BMJ. 2011 Jul 22;343:d4002
references.pmid: 21784880