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Green N, Lamrock F, Naylor N, Williams J, Briggs A. Health Economic Evaluation Using Markov Models in R for Microsoft Excel Users: A Tutorial. PHARMACOECONOMICS 2023; 41:5-19. [PMID: 36336774 DOI: 10.1007/s40273-022-01199-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
A health economic evaluation (HEE) is a comparative analysis of alternative courses of action in terms of both costs and consequences. A cost-effectiveness analysis is a type of HEE that compares an intervention to one or more alternatives by estimating how much it costs to gain an additional unit of health outcome. Cost-effectiveness analyses are commonly performed using Microsoft (MS) Excel. However, there is current interest in using other software that is better suited to more complex problems, methods, and data, as well as improved reproducibility and transparency. That is, it is increasingly important to be able to repeat an analysis of a particular data set and obtain the same results, and access the analysis and results in a clear and comprehensive openly available form. In this tutorial we provide a step-by-step guide on how to implement a mainstay model of HEE, namely a Markov model, in the statistical programming language R. The adoption of R for the purpose of cost-effectiveness analysis is highly dependent on the ability of the health economic modeller to understand, learn, and apply programming-type skills. R is likely to be less familiar than MS Excel for many modellers and so coding a cost-effectiveness model in R can be a large jump. We describe the technical details from the perspective of a MS Excel user to help bridge the gap between software and reduce the learning curve by providing for the first-time side-by-side comparisons of the Markov model example in MS Excel and R.
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Affiliation(s)
- Nathan Green
- Department of Statistical Science, University College London, London, UK
| | - Felicity Lamrock
- Mathematical Sciences Research Centre, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Nichola Naylor
- HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Williams
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Kohli-Lynch CN, Lewsey J, Boyd KA, French DD, Jordan N, Moran AE, Sattar N, Preiss D, Briggs AH. Beyond Ten-Year Risk: A Cost-Effectiveness Analysis of Statins for the Primary Prevention of Cardiovascular Disease. Circulation 2022; 145:1312-1323. [PMID: 35249370 PMCID: PMC9022692 DOI: 10.1161/circulationaha.121.057631] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cholesterol guidelines typically prioritize primary prevention statin therapy on the basis of 10-year risk of cardiovascular disease. The advent of generic pricing may justify expansion of statin eligibility. Moreover, 10-year risk may not be the optimal approach for statin prioritization. We estimated the cost-effectiveness of expanding preventive statin eligibility and evaluated novel approaches to prioritization from a Scottish health sector perspective.
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Affiliation(s)
- Ciaran N Kohli-Lynch
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - James Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Dustin D French
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, Illinois; Department of Ophthalmology and Medical Social Science, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neil Jordan
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, Illinois; Departments of Psychiatry & Behavioral Sciences and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York City, New York
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Preiss
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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