PharmacoEconomics

, Volume 13, Issue 4, pp 397–409 | Cite as

An Introduction to Markov Modelling for Economic Evaluation

Leading Article Markov Modelling

Summary

Markov models are often employed to represent stochastic processes, that is, random processes that evolve over time. In a healthcare context, Markov models are particularly suited to modelling chronic disease. In this article, we describe the use of Markov models for economic evaluation of healthcare interventions. The intuitive way in which Markov models can handle both costs and outcomes make them a powerful tool for economic evaluation modelling. The time component of Markov models can offer advantages of standard decision tree models, particularly with respect to discounting. This paper gives a comprehensive description of Markov modelling for economic evaluation, including a discussion of the assumptions on which the type of model is based, most notably the memoryless quality of Markov models often termed the ‘Markovian assumption’. A hypothetical example of a drug intervention to slow the progression of a chronic disease is employed to demonstrate the modelling technique and the possible methods of analysing Markov models are explored. Analysts should be aware of the limitations of Markov models, particularly the Markovian assumption, although the adept modeller will often find ways around this problem.

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References

  1. 1.
    Buxton MJ, Drummond MF, van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6: 217–27PubMedCrossRefGoogle Scholar
  2. 2.
    Eddy DM. Technology assessment: the role of mathematical modelling. In: Mosteller F, editor. Assessing medical technologies. Washington, DC: National Academy Press, 1985: 144–53Google Scholar
  3. 3.
    Michaels JA, Galland RB. Management of asymptomatic popliteal aneurysms: the use of a Markov decision tree to determine the criteria for a conservative approach. Eur J Vasc Surg 1993; 7 (2): 136–43PubMedCrossRefGoogle Scholar
  4. 4.
    Barnhart HX, Caldwell MB, Thomas P, et al. Natural history of human immunodeficiency virus disease in perinatally infected children: an analysis from the Pediatric Spectrum of Disease Project. Pediatrics 1996; 97 (5): 710–6PubMedGoogle Scholar
  5. 5.
    Ludbrook A. A cost—effectiveness analysis of the treatment of chronic renal failure. Appl Econ 1981; 13: 337–50CrossRefGoogle Scholar
  6. 6.
    Hillner BE, Mc Leod DG, Crawford ED, et al. Estimating the cost effectiveness of total androgen blockade with flutamide in M1 prostate cancer. Urology 1995; 45 (5): 633–40PubMedCrossRefGoogle Scholar
  7. 7.
    Sculpher M, Michaels J, Mc Kenna M, et al. A cost—utility analysis of laser—assisted angioplasty for peripheral arterial occlusions. Int J Technol Assess Health Care 1996; 12 (1): 104–25PubMedCrossRefGoogle Scholar
  8. 8.
    Briggs AH, Sculpher MJ, Logan RP, et al. Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age. BMJ. 1996; 312 (7042): 1321–5PubMedCrossRefGoogle Scholar
  9. 9.
    Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993; 13: 322–38PubMedCrossRefGoogle Scholar
  10. 10.
    Bloom BS, Fendrick AM. Timing and timeliness in medicalcare evaluation. Pharmacoeconomics 1996; 9 (3): 183–7PubMedCrossRefGoogle Scholar
  11. 11.
    Sculpher MJ, Drummond MF, Buxton MJ. The iterative use of economic evaluation as part of the process of health technology assessment. J Health Serv Res Policy 1997; 2: 26–30PubMedGoogle Scholar
  12. 12.
    Clemens K, Garrison LP, Jones A, et al. Strategic use of pharmacoeconomic research in early drug development and global pricing. Pharmacoeconomics 1993; 4 (5): 315–22PubMedCrossRefGoogle Scholar
  13. 13.
    Torgerson D, Donaldson C, Reid D. Using economics to prioritize research: a case study of randomized trials for the prevention of hip fractures due to osteoporosis. J Health Serv Res Policy 1996; 1: 141–6PubMedGoogle Scholar
  14. 14.
    Townsend J, Buxton M. Cost—effectiveness scenario analysis for a proposed trial of hormone replacement therapy. Health Policy 1997; 39: 181–94PubMedCrossRefGoogle Scholar
  15. 15.
    Glick H, Heyse JF, Thompson D, et al. A model for evaluating the cost—effectiveness of cholesterol—lowering treatment. Int J Technol Assess Health Care 1992; 8 (4): 719–34PubMedCrossRefGoogle Scholar
  16. 16.
    Shepherd J, Cobbe SM, Ford I, West of Scotland Coronary Prevention Study Group, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333 (20): 1301–7PubMedCrossRefGoogle Scholar
  17. 17.
    Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344 (8934): 1383–9Google Scholar
  18. 18.
    Johannesson M, Jonsson B, Kjekshus J, Scandinavian Simvastatin Survival Study Group, et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336 (5): 332–6PubMedCrossRefGoogle Scholar
  19. 19.
    Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995; 332 (21): 1418–24PubMedCrossRefGoogle Scholar
  20. 20.
    Bryan S, Brown J. Extrapolation of cost—effectiveness information to local settings. Brunel: Brunel University, 1997. Health Economics Research Group (HERG) discussion paper no.: 17Google Scholar
  21. 21.
    Gompertz B. On the nature of the of the function expressive of the law of human mortality. Phil Trans R Soc Lond 1825; 115: 513–85CrossRefGoogle Scholar
  22. 22.
    Neilson S, Robinson I, Hunter M. Static and dynamic models of interdisease competition: past and projected mortality from amyotrophic lateral sclerosis and multiple sclerosis. Mech Ageing Dev 1993; 66: 223–41PubMedCrossRefGoogle Scholar
  23. 23.
    Miller DK, Homan SM. Determining transition probabilities: confusion and suggestions. Med Decis Making 1994; 14: 52–8PubMedCrossRefGoogle Scholar
  24. 24.
    Johannesson M. On the discounting of gained life—years in costeffectiveness analysis. Int J Technol Assess Health Care 1992; 8 (2): 359–64PubMedCrossRefGoogle Scholar
  25. 25.
    Parsonage M, Neuburger H. Discounting and health benefits. Health Econ 1992; 1 (1): 71–6PubMedCrossRefGoogle Scholar
  26. 26.
    Cairns J. Discounting and health benefits: another perspective. Health Econ 1992; 1 (1): 76–9PubMedCrossRefGoogle Scholar
  27. 27.
    Black N. Why we need observational studies to evaluate the effectiveness of health care. BMJ 1996; 312 (7040): 1215–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1998

Authors and Affiliations

  1. 1.Health Economics Research Centre, Institute of Health SciencesUniversity of OxfordHeadington, OxfordEngland
  2. 2.Centre for Health EconomicsUniversity of YorkYorkEngland

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