Senanayake Sameera, Graves Nicholas, Healy Helen, Baboolal Keshwar, Barnett Adrian, Kularatna Sanjeewa
Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
Duke-NUS Medical School, 8 College road, Singapore, Singapore.
Health Econ Rev. 2021 Apr 15;11(1):13. doi: 10.1186/s13561-021-00312-4.
Economic-evaluations using decision analytic models such as Markov-models (MM), and discrete-event-simulations (DES) are high value adds in allocating resources. The choice of modelling method is critical because an inappropriate model yields results that could lead to flawed decision making. The aim of this study was to compare cost-effectiveness when MM and DES were used to model results of transplanting a lower-quality kidney versus remaining waitlisted for a kidney.
Cost-effectiveness was assessed using MM and DES. We used parametric survival models to estimate the time-dependent transition probabilities of MM and distribution of time-to-event in DES. MMs were simulated in 12 and 6 monthly cycles, out to five and 20-year time horizon.
DES model output had a close fit to the actual data. Irrespective of the modelling method, the cycle length of MM or the time horizon, transplanting a low-quality kidney as compared to remaining waitlisted was the dominant strategy. However, there were discrepancies in costs, effectiveness and net monetary benefit (NMB) among different modelling methods. The incremental NMB of the MM in the 6-months cycle lengths was a closer fit to the incremental NMB of the DES. The gap in the fit of the two cycle lengths to DES output reduced as the time horizon increased.
Different modelling methods were unlikely to influence the decision to accept a lower quality kidney transplant or remain waitlisted on dialysis. Both models produced similar results when time-dependant transition probabilities are used, most notable with shorter cycle lengths and longer time-horizons.
使用马尔可夫模型（MM）和离散事件模拟（DES）等决策分析模型进行经济评估，在资源分配方面具有很高的价值。建模方法的选择至关重要，因为不恰当的模型会产生可能导致错误决策的结果。本研究的目的是比较使用MM和DES对低质量肾脏移植结果与继续等待肾脏移植进行建模时的成本效益。
使用MM和DES评估成本效益。我们使用参数生存模型来估计MM的时间依赖性转移概率和DES中事件发生时间的分布。MM在12个月和6个月的周期内进行模拟，时间跨度为5年和20年。
DES模型输出与实际数据拟合良好。无论建模方法、MM的周期长度或时间跨度如何，与继续等待相比，移植低质量肾脏是主要策略。然而，不同建模方法在成本、效益和净货币效益（NMB）方面存在差异。6个月周期长度的MM的增量NMB与DES的增量NMB更接近。随着时间跨度的增加，两种周期长度与DES输出的拟合差距减小。
不同的建模方法不太可能影响接受低质量肾脏移植或继续等待透析的决策。当使用时间依赖性转移概率时，两种模型产生相似的结果，在较短的周期长度和较长的时间跨度下最为明显。
