Abstract
This paper itemises the current and developing roles of modelling in health economic evaluation and discusses its value in each role.
We begin by noting the emptiness of the dichotomy that some commentators have sought to create between modelling and controlled trials as mechanisms for informing decisions. Both are necessary parts of the armoury. Recent literature discussions are examined and the accelerating prevalence of modelling is reported.
The identified roles include: extrapolating outcomes to the longer term; adjusting for prognostic factors in trials; translating from intermediate to final outcomes; extending analysis to the relevant comparators; generalising from specific trial populations to the full target group for an intervention and to other settings and countries; systematic sensitivity analyses; and the use of modelling for the design and prioritisation of future trials.
Roles are illustrated with 20 recent examples, mostly from within our own work analysing new or contentious interventions for the Trent Development and Evaluation Committee, which is planned to be incorporated into the UK National Institute for Clinical Excellence (NICE). Each role discussed has been essential at some point in this policy-making forum.
Finally, the importance of quality assurance, critical review and validity testing is reiterated and there are some observations on processes to ensure probity and quality.
Similar content being viewed by others
References
Canadian Co-ordinating Office for Health Technology Assessment. Guidelines for the economic evaluation of pharmaceuticals. 1st ed. Ottawa: CCOHTA, 1994
Department of Health, Housing and Community Services. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Government Publishing Service, 1995
Eddy DM. Assessing medical technology. In: Eddy DM, editor. Technology assessment: the role of mathematical modelling. Washington, DC: National Academy Press, 1985: 144–75
Eddy D. Should we change the rules for evaluating medical technologies? In: Gelijns A, editor. Modern methods of clinical investigation. Washington, DC: National Academy Press, 1990
Rittenhouse B. Uses of models in economic evaluations of medicines and other health technologies. London: Office of Health Economics, 1996
Luce BR. Policy implications of modelling the cost-effectiveness of health care technologies. Drug Info J 1995; 29: 1469–75
Kassirer JP, Angell M. The journal’s policy on cost-effectiveness analyses [editorial]. N Engl J Med 1994; 331 (10): 669–70
Task Force on Principles for Economic Analysis of Health Care Technology. Economic analysis of health care technology: a report on principles. Ann Intern Med 1995; 122: 60–9
Revicki DA, Frank L. Pharmacoeconomic evaluation in the resal world: effectiveness versus efficacy studies. Pharmacoeconomics 1999: 5 (5): 423–34
Rizzo JD, Powe NR. Methodological hurdles in conducting pharmacoeconomic analyses. Pharmacoeconomics 1999: 15 (4): 339–55
Sheldon TA. Problems of using modelling in the economic evaluation of health care. Health Econ 1996; 5: 1–11
Buxton MJ, Drummond MF, Van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6: 217–27
OHE Briefing. The pros and cons of modelling in economic evaluation. London: Office of Health Economics, 1997
Office of Health Economics. Handbook of the Office of Health Economics database of health economic evaluations. London: Office of Health Economics, 1998
McGuire WP, Hoskins WJ, Brady MF, et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996; 334 (1): 1–6
Beard SM, Coleman R, Radford J, et al. The use of cisplatin and paclitaxel as a first line treatment in ovarian cancer. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1997
Chilcott J, Golightly P, Jefferson D, et al. The use of riluzole in the treatment of amyotrophic lateral sclerosis. Sheffield: Trent Institute for Health Services Research, 1997
Cummings C. The use of olanzapine as a first and second choice treatment in schizophrenia. Birmingham: Department of Public Health and Epidemiology, University of Birmingham, 1998
Beard SM, Brewin J, Packham C, et al. A review of the use of current atypical antipsychotics in the treatment of schizophrenia. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1998
US General Accounting Office. Cross-design synthesis: a new strategy for medical effectiveness research [US GAO/PEMD-92-18]. Washington, DC: US General Accounting Office, 1992
Drummond MF, Davies L. Economic analysis alongside clinical trials. Int J Technol Assess Health Care 1991; 7: 561–73
Knight C. Modelling Helicobactor pylori eradication: the HEALS model. Project report to Abbott Pharmaceutical. Sheffield: School of Health and Related Research, University of Sheffield, 1999
European Society of Primary Care Gastroenterology (ESCPG). Pan-European consensus on patient management strategies for H. pylori: the management of H. pylori infection [bulletin]. ESPCG Pan-European Consensus on Patient Management Strategies for H. pylori; 1998 May 9–10; Zurich
Stevenson MD, Richards RG, Beard SM. The health economics of asthma and the role of antileukotrienes in the treatment of chronic asthma. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1999
Beard SM, Ward SE, Brennan A. ScHARR Project Report to SmithKline Beecham: sensitivity analysis of the ‘ADEPT’ Depression Management Model. Sheffield: School of Health and Related Research, University of Sheffield, 1997
Akehurst RL, Chilcott, JB, Holmes MW, et al. The economic implications of the use of basiliximab versus placebo for the control of acute cellular rejection in renal allograft recipients. Sheffield: School of Health and Related Research, University of Sheffield, 1999
Pickin MD, Payne JN, Haq IU, et al. Statin therapy/HMG-CoA reductase inhibitor treatment in the prevention of coronary heart disease. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1996
University of York. Cholesterol and coronary heart disease: screening and treatment. Eff Health Care 1998; 4 (11): 1–16
Chilcott JB, Brennan A. Systematic review of the use of modelling in planning and prioritising clinical trials. International Society for Technology Assessment in Health Care (ISTAHC) Conference; 1999 Jun 20–23; Edinburgh
Sculpher M, Drummond M, Buxton M. The iterative use of economic evaluation as part of the process of health technology assessment. J Health Serv Res Policy 1997; 2: 26–30
Fenwick E, Sculpher M, Claxton K, et al. The role of decision analytical modelling improving the efficiency and relevance of health technology assessment. York: Health Economics Study Group, 1998
Claxton K, Posnett J. An economic approach to clinical trial design and research priority setting. Health Econ 1996; 5 (6): 513–24
Detsky AS. Using cost-effectiveness analysis to improve the efficiency of allocating funds to clinical trials. Stat Med 1990; 9: 173–84
Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 1994; 3: 95–104
Beard SM, Lorigan P, Sampson F, et al. The effectiveness of high dose chemotherapy with autologous stem cell transplantation in the treatment of Hodgkin’s disease and non-Hodgkin’s lymphoma. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1998.
Beard SM, Sampson FC, Vandenberghe E, et al. The effectiveness of high dose chemotherapy with autologous stem cell/bone marrow transplantation in the treatment of multiple myeloma. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1998
Stevenson MD, Beard SM, Oakley PA, et al. Modelling of the potential impact of a regional trauma system in patients with severe head injury. Sheffield: School of Health and Related Research, University of Sheffield, 1998
The ScHARR statins prescribing model. Available from URL: http://www.shef.ac.uk/~scharr/or/statins/ [Accessed 2000 Mar 20]
Beard SM, Holmes M, Majeed A, et al. Hepatic resection as a treatment for liver metastases in colorectal cancer. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1999
Beard SM, Perez I, Touch S, et al. Magnetic resonance imaging (MRI) in the management of knee disorders. Sheffield: Trent Institute for Health Services Research, Universities of Leicester, Nottingham and Sheffield, 1998
Robinson S. Successful simulation: a practical approach to simulation projects. London: McGraw-Hill, 1994
Robinson S, Pidd M. Provider and customer expectations of successful simulation projects. J Oper Res Soc 1998; 49: 200–9
Gass SI. OR in the real world: how things go wrong. Comput Oper Res 1991; 18 (7): 629–32
Fossett CA, Harrison D, Weintrob H. An assessment procedure for simulation models: a case study. Operations Res Soc Am 1991; 39 (5): 710–24
Finlay PN, Wilson JM. Orders of validation in mathematical modelling. J Oper Res Soc 1990; 41 (2): 103–9
Gass SI. Model accreditation: a rationale and process for determining a numerical rating. Eur J Oper Res 1993; 66: 250–8
Finlay PN, Forsey GJ, Wilson JM. The validation of expert systems: contrasts with traditional methods. J Oper Res Soc 1988; 39 (10): 933–8
Sonnenberg FA, Roberts MS, Tsevat J, et al. Toward a peer review process for medical decision analysis models. Med Care 1994; 32 (7): JS52–64
Delamothe T, Smith R. Moving beyond journals: the future arrives with a crash. BMJ 1999; 318: 1637–9
Acknowledgements
This paper could not have been written without the Trent Institute Acute Purchasing Working Group and the staff of the Operational Research Section of ScHARR. Thanks are particularly due to Chris McCabe for initiating the consensus conference and Steve Gallivan who was discussant for the paper.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brennan, A., Akehurst, R. Modelling in Health Economic Evaluation. Pharmacoeconomics 17, 445–459 (2000). https://doi.org/10.2165/00019053-200017050-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-200017050-00004