Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 30:8:569500.
doi: 10.3389/fpubh.2020.569500. eCollection 2020.

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

Andrea Carta  1 , Claudio Conversano  1
Affiliations

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

Andrea Carta et al. Front Public Health. .

Abstract

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.

Keywords: Dengue fever; Markov models; cost-utility analysis; incremental cost-effectiveness ratio; pharmacoeconomics; willingness to pay.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Incremental cost effectiveness ratio: four quadrant representation.
Figure 2
Figure 2
An example of Decision Tree diagram.
Figure 3
Figure 3
An example of Markov model transition diagram.
Figure 4
Figure 4
The semi Markov model for the Dengue fever disease.
Figure 5
Figure 5
Tornado diagram of deterministic sensitivity analysis.
Figure 6
Figure 6
Cost effectiveness plane.
Figure 7
Figure 7
Cost effectiveness acceptability curve.
Figure 8
Figure 8
Covariance analysis of PSA result.
Figure 9
Figure 9
Relationship between vaccine cost and ICER.
Figure 10
Figure 10
Relationship between time span cost and ICER.
Figure 11
Figure 11
Example of the use of tunnel states in a Dengue fever model.
See this image and copyright information in PMC

References

    1. World Health Organization Global Spending on Health: A World in Transition. Geneva: World Health Organization; (2019).
    1. Thomas D, Hiligsmann M, John D, Al Ahdab OG, Li H. Pharmacoeconomic analyses and modeling. In: Thomas D, editor. Clinical Pharmacy Education, Practice and Research. Amsterdam, NL: Elsevier; (2019). p. 261–75. 10.1016/B978-0-12-814276-9.00018-0 - DOI
    1. Bootman JL, Townsend RJ, McGhan WF. Chapter 1: Introduction to pharmacoeconomics. In: Bootman JL, Townsend RJ, McGhan WF, editors. Principles of Pharmacoeconomics. 2nd ed Cincinnati, OH: Harvey Whitney Books Company; (1996). p. 4–19
    1. Milne RJ. Pharmacoeconomic models in disease management. Dis Manage Health Outcomes. (1998) 4:119–34. 10.2165/00115677-199804030-00001 - DOI
    1. Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ. (2002) 11:415–30. 10.1002/hec.678 - DOI - PubMed

Publication types