# A Comparison of Four Software Programs for Implementing Decision Analytic Cost-Effectiveness Models

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## Abstract

The volume and technical complexity of both academic and commercial research using decision analytic modelling has increased rapidly over the last two decades. The range of software programs used for their implementation has also increased, but it remains true that a small number of programs account for the vast majority of cost-effectiveness modelling work. We report a comparison of four software programs: TreeAge Pro, Microsoft Excel, R and MATLAB. Our focus is on software commonly used for building Markov models and decision trees to conduct cohort simulations, given their predominance in the published literature around cost-effectiveness modelling. Our comparison uses three qualitative criteria as proposed by Eddy et al.: “transparency and validation”, “learning curve” and “capability”. In addition, we introduce the quantitative criterion of processing speed. We also consider the cost of each program to academic users and commercial users. We rank the programs based on each of these criteria. We find that, whilst Microsoft Excel and TreeAge Pro are good programs for educational purposes and for producing the types of analyses typically required by health technology assessment agencies, the efficiency and transparency advantages of programming languages such as MATLAB and R become increasingly valuable when more complex analyses are required.

## Keywords

Health Technology Assessment Integrate Development Environment Health Technology Assessment Agency Debug Tool Markov Tree## Notes

## Compliance with Ethical Standards

## Funding

This study was funded through grants from the Canadian Institutes for Health Research (CIHR) and Genome Canada. Christopher McCabe is supported through a Capital Health Research Chair in Emergency Medicine Research.

## Conflicts of interest

Mike Paulden and Christopher McCabe have taught introductory courses on decision modelling using Microsoft Excel, but have no relationships with the developer and have received no financial benefits for using this software to teach these courses. Petros Pechlivanoglou has taught introductory courses on decision modelling using R and has contributed to decision modelling courses that use TreeAge, but has no relationships with any of the developers and has received no financial benefits for using this software to teach these courses. Chase Hollman, Mike Paulden, Petros Pechlivanoglou and Christopher McCabe have no other potential conflicts of interest to report.

## Author contributions

Mike Paulden built the TreeAge model used for the benchmark comparisons and rebuilt this model using Microsoft Excel. Chase Hollman rebuilt this model in MATLAB and R, with support from Petros Pechlivanoglou, and conducted the benchmarking exercise. Christopher McCabe supervised the project. Chase Hollman wrote the first draft of the manuscript. All authors contributed to subsequent drafts of the manuscript, responses to peer review, and preparation of the manuscript for publication.

## Data availability statement

We have provided the models used in our benchmarking exercise as supplementary material.

## Supplementary material

## References

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