Skip to main content
Erschienen in: PharmacoEconomics 3/2012

01.03.2012 | Current Opinion

Population–versus Cohort–Based Modelling Approaches

verfasst von: Dr Olivier Ethgen, Baudouin Standaert

Erschienen in: PharmacoEconomics | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

While no single type of model can provide adequate answers under all circumstances, any modelling endeavour should incorporate three fundamental considerations in any decision-making question: the target population, the disease and the intervention characteristics.
A target population is likely to be characterized by various types of heterogeneity and a dynamic evolution over time. It is therefore important to adequately capture these population effects on the results of a model. There are essentially two different approaches in modelling a population over time: a cohort-based approach and a population-based approach.
In a cohort-based model, a closed group of individuals who have at least one specific characteristic or experience in common over a defined period of time is run through a state transition process. The cohort is generally composed of a hypothetical number of representative or ‘average’ individuals (i.e. the target population is considered to be a homogeneous group).
The population-based approach projects the evolution of the estimated prevalent target population and intends to reflect as much as possible the demographic, epidemiological and clinical characteristics of the prevalent target population relevant for the decision problem.
A cohort-based approach is generally used in most published healthcare decision models. However, this choice is rarely discussed by modellers. In this article, we challenge this assumption. To address the underlying decision problem, we affirm it is crucial that modellers consider the characteristics of the target population. Then, they could opt for using the most appropriate approach. Decision makers should also understand the impact on the results of both types of models in order to make informed healthcare decisions.
Literatur
1.
Zurück zum Zitat Brennan A, Akehurst R. Modelling in health economic evaluation. What is its place? What is its value? Pharmacoeconomics 2000; 17 (5): 445–59 Brennan A, Akehurst R. Modelling in health economic evaluation. What is its place? What is its value? Pharmacoeconomics 2000; 17 (5): 445–59
2.
Zurück zum Zitat Buxton MJ, Drummond MF, Van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6 (3): 217–27PubMedCrossRef Buxton MJ, Drummond MF, Van Hout BA, et al. Modelling in economic evaluation: an unavoidable fact of life. Health Econ 1997; 6 (3): 217–27PubMedCrossRef
3.
Zurück zum Zitat Sun X, Faunce T. Decision-analytical modelling in health-care economic evaluations. Eur J Health Econ 2008; 9 (4): 313–23PubMedCrossRef Sun X, Faunce T. Decision-analytical modelling in health-care economic evaluations. Eur J Health Econ 2008; 9 (4): 313–23PubMedCrossRef
4.
Zurück zum Zitat Sculpher M, Fenwick E, Claxton K. Assessing quality in decision analytic cost-effectiveness models: a suggested framework and example of application. Pharmacoeconomics 2000; 17 (5): 461–77PubMedCrossRef Sculpher M, Fenwick E, Claxton K. Assessing quality in decision analytic cost-effectiveness models: a suggested framework and example of application. Pharmacoeconomics 2000; 17 (5): 461–77PubMedCrossRef
5.
Zurück zum Zitat Soto J. Health economic evaluations using decision analytic modeling: principles and practices–utilization of a checklist to their development and appraisal. Int J Technol Assess Health Care 2002; 18 (1): 94–111PubMed Soto J. Health economic evaluations using decision analytic modeling: principles and practices–utilization of a checklist to their development and appraisal. Int J Technol Assess Health Care 2002; 18 (1): 94–111PubMed
6.
Zurück zum Zitat Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices–Modeling Studies. Value Health 2003; 6 (1): 9–17PubMedCrossRef Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices–Modeling Studies. Value Health 2003; 6 (1): 9–17PubMedCrossRef
7.
Zurück zum Zitat Kim SY, Goldie SJ. Cost-effectiveness analyses of vaccination programmes: a focused review of modelling approaches. Pharmacoeconomics 2008; 26 (3): 191–215PubMedCrossRef Kim SY, Goldie SJ. Cost-effectiveness analyses of vaccination programmes: a focused review of modelling approaches. Pharmacoeconomics 2008; 26 (3): 191–215PubMedCrossRef
8.
Zurück zum Zitat Brennan A, Chick SE, Davies R. A taxonomy of model structures for economic evaluation of health technologies. Health Econ 2006; 15 (12): 1295–310PubMedCrossRef Brennan A, Chick SE, Davies R. A taxonomy of model structures for economic evaluation of health technologies. Health Econ 2006; 15 (12): 1295–310PubMedCrossRef
9.
Zurück zum Zitat Barton P, Bryan S, Robinson S. Modelling in the economic evaluation of health care: selecting the appropriate approach. J Health Serv Res Policy 2004; 9 (2): 110–8PubMedCrossRef Barton P, Bryan S, Robinson S. Modelling in the economic evaluation of health care: selecting the appropriate approach. J Health Serv Res Policy 2004; 9 (2): 110–8PubMedCrossRef
10.
Zurück zum Zitat Heeg BM, Damen J, Buskens E, et al. Modelling approaches: the case of schizophrenia. Pharmacoeconomics 2008; 26 (8): 633–48PubMedCrossRef Heeg BM, Damen J, Buskens E, et al. Modelling approaches: the case of schizophrenia. Pharmacoeconomics 2008; 26 (8): 633–48PubMedCrossRef
11.
Zurück zum Zitat Karnon J. Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation. Health Econ 2003; 12 (10): 837–48PubMedCrossRef Karnon J. Alternative decision modelling techniques for the evaluation of health care technologies: Markov processes versus discrete event simulation. Health Econ 2003; 12 (10): 837–48PubMedCrossRef
12.
Zurück zum Zitat Simpson KN, Strassburger A, Jones WJ, et al. Comparison of Markov model and discrete-event simulation techniques for HIV. Pharmacoeconomics 2009; 27 (2): 159–65PubMedCrossRef Simpson KN, Strassburger A, Jones WJ, et al. Comparison of Markov model and discrete-event simulation techniques for HIV. Pharmacoeconomics 2009; 27 (2): 159–65PubMedCrossRef
13.
Zurück zum Zitat Stahl JE. Modelling methods for pharmacoeconomics and health technology assessment: an overview and guide. Pharmacoeconomics 2008; 26 (2): 131–48PubMedCrossRef Stahl JE. Modelling methods for pharmacoeconomics and health technology assessment: an overview and guide. Pharmacoeconomics 2008; 26 (2): 131–48PubMedCrossRef
14.
Zurück zum Zitat Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 2000; 17 (5): 479–500PubMedCrossRef Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 2000; 17 (5): 479–500PubMedCrossRef
15.
Zurück zum Zitat Griffin S, Claxton K, Hawkins N, et al. Probabilistic analysis and computationally expensive models: Necessary and required? Value Health 2006; 9 (4): 244–52PubMedCrossRef Griffin S, Claxton K, Hawkins N, et al. Probabilistic analysis and computationally expensive models: Necessary and required? Value Health 2006; 9 (4): 244–52PubMedCrossRef
16.
Zurück zum Zitat Hoyle M, Anderson R. Whose costs and benefits? Why economic evaluations should simulate both prevalent and all future incident patient cohorts. Med Decis Making 2010; 30 (4): 426–37 Hoyle M, Anderson R. Whose costs and benefits? Why economic evaluations should simulate both prevalent and all future incident patient cohorts. Med Decis Making 2010; 30 (4): 426–37
17.
Zurück zum Zitat Kuntz KM, Fenwick E, Briggs A. Appropriate cohorts for cost-effectiveness analysis: to mix or not to mix? Med Decis Making 2010; 30 (4): 424–5PubMedCrossRef Kuntz KM, Fenwick E, Briggs A. Appropriate cohorts for cost-effectiveness analysis: to mix or not to mix? Med Decis Making 2010; 30 (4): 424–5PubMedCrossRef
18.
Zurück zum Zitat Philips Z, Bojke L, Sculpher M, et al. Good practice guidelines for decision-analytic modelling in health technology assessment: a review and consolidation of quality assessment. Pharmacoeconomics 2006; 24 (4): 355–71PubMedCrossRef Philips Z, Bojke L, Sculpher M, et al. Good practice guidelines for decision-analytic modelling in health technology assessment: a review and consolidation of quality assessment. Pharmacoeconomics 2006; 24 (4): 355–71PubMedCrossRef
19.
Zurück zum Zitat Sculpher M. Subgroups and heterogeneity in cost-effectiveness analysis. Pharmacoeconomics 2008; 26 (9): 799–806PubMedCrossRef Sculpher M. Subgroups and heterogeneity in cost-effectiveness analysis. Pharmacoeconomics 2008; 26 (9): 799–806PubMedCrossRef
20.
Zurück zum Zitat Kuntz KM, Goldie SJ. Assessing the sensitivity of decisionanalytic results to unobserved markers of risk: defining the effects of heterogeneity bias. Med Decis Making 2002; 22 (3): 218–27PubMed Kuntz KM, Goldie SJ. Assessing the sensitivity of decisionanalytic results to unobserved markers of risk: defining the effects of heterogeneity bias. Med Decis Making 2002; 22 (3): 218–27PubMed
21.
Zurück zum Zitat Zaric GS. The impact of ignoring population heterogeneity when Markov models are used in cost-effectiveness analysis. Med Decis Making 2003; 23 (5): 379–96PubMedCrossRef Zaric GS. The impact of ignoring population heterogeneity when Markov models are used in cost-effectiveness analysis. Med Decis Making 2003; 23 (5): 379–96PubMedCrossRef
22.
Zurück zum Zitat Mauskopf JA, Earnshaw S, Mullins CD. Budget impact analysis: review of the state of the art. Expert Rev Pharmacoecon Outcomes Res 2005; 5 (1): 65–79PubMedCrossRef Mauskopf JA, Earnshaw S, Mullins CD. Budget impact analysis: review of the state of the art. Expert Rev Pharmacoecon Outcomes Res 2005; 5 (1): 65–79PubMedCrossRef
23.
Zurück zum Zitat Kuntz K, Weinstein M. Modelling in economic evaluation. In: Drummond M, McGuire A, editors. Economic evaluation in health care–from theory to practice. Oxford: Oxford University Press, 2001: 141–71 Kuntz K, Weinstein M. Modelling in economic evaluation. In: Drummond M, McGuire A, editors. Economic evaluation in health care–from theory to practice. Oxford: Oxford University Press, 2001: 141–71
24.
Zurück zum Zitat Mauskopf J. Meeting the NICE requirements: a Markov model approach. Value Health 2000; 3 (4): 287–93PubMedCrossRef Mauskopf J. Meeting the NICE requirements: a Markov model approach. Value Health 2000; 3 (4): 287–93PubMedCrossRef
25.
Zurück zum Zitat Dewilde S, Anderson R. The cost-effectiveness of screening programs using single and multiple birth cohort simulations: a comparison using a model of cervical cancer. Med Decis Making 2004; 24 (5): 486–92PubMedCrossRef Dewilde S, Anderson R. The cost-effectiveness of screening programs using single and multiple birth cohort simulations: a comparison using a model of cervical cancer. Med Decis Making 2004; 24 (5): 486–92PubMedCrossRef
26.
Zurück zum Zitat Standaert B, Demarteau N, Talbird S, et al. Modelling the effect of conjugate vaccines in pneumococcal disease: cohort or population models? Vaccine 2010; 28 Suppl. 6: G30–8CrossRef Standaert B, Demarteau N, Talbird S, et al. Modelling the effect of conjugate vaccines in pneumococcal disease: cohort or population models? Vaccine 2010; 28 Suppl. 6: G30–8CrossRef
27.
Zurück zum Zitat Vanness DJ, Tosteson AN, Gabriel SE, et al. The need for microsimulation to evaluate osteoporosis interventions. Osteoporos Int 2005; 16 (4): 353–8PubMedCrossRef Vanness DJ, Tosteson AN, Gabriel SE, et al. The need for microsimulation to evaluate osteoporosis interventions. Osteoporos Int 2005; 16 (4): 353–8PubMedCrossRef
28.
Zurück zum Zitat Weinstein MC. Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 2006; 24 (11): 1043–53PubMedCrossRef Weinstein MC. Recent developments in decision-analytic modelling for economic evaluation. Pharmacoeconomics 2006; 24 (11): 1043–53PubMedCrossRef
29.
Zurück zum Zitat Hiligsmann M, Ethgen O, Bruyere O, et al. Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health 2009; 12: 687–96PubMedCrossRef Hiligsmann M, Ethgen O, Bruyere O, et al. Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health 2009; 12: 687–96PubMedCrossRef
30.
Zurück zum Zitat Coyle D, Buxton MJ, O’Brien BJ. Stratified costeffectiveness analysis: a framework for establishing efficient limited use criteria. Health Econ 2003; 12 (5): 421–7PubMedCrossRef Coyle D, Buxton MJ, O’Brien BJ. Stratified costeffectiveness analysis: a framework for establishing efficient limited use criteria. Health Econ 2003; 12 (5): 421–7PubMedCrossRef
31.
Zurück zum Zitat Trusheim MR, Berndt ER, Douglas FL. Stratified medicine: strategic and economic implications of combining drugs and clinical biomarkers. Nat Rev Drug Discov 2007; 6 (4): 287–93PubMedCrossRef Trusheim MR, Berndt ER, Douglas FL. Stratified medicine: strategic and economic implications of combining drugs and clinical biomarkers. Nat Rev Drug Discov 2007; 6 (4): 287–93PubMedCrossRef
32.
Zurück zum Zitat Salomon JA, Weinstein MC, Goldie SJ. Taking account of future technology in cost effectiveness analysis. BMJ 2004; 329 (7468): 733–6PubMedCrossRef Salomon JA, Weinstein MC, Goldie SJ. Taking account of future technology in cost effectiveness analysis. BMJ 2004; 329 (7468): 733–6PubMedCrossRef
33.
Zurück zum Zitat Palmer S, Smith PC. Incorporating option values into the economic evaluation of health care technologies. J Health Econ 2000; 19 (5): 755–66PubMedCrossRef Palmer S, Smith PC. Incorporating option values into the economic evaluation of health care technologies. J Health Econ 2000; 19 (5): 755–66PubMedCrossRef
34.
Zurück zum Zitat Philips Z, Claxton K, Palmer S. The half-life of truth: what are appropriate time horizons for research decisions? Med Decis Making 2008; 28 (3): 287–99PubMedCrossRef Philips Z, Claxton K, Palmer S. The half-life of truth: what are appropriate time horizons for research decisions? Med Decis Making 2008; 28 (3): 287–99PubMedCrossRef
35.
Zurück zum Zitat Hoyle M. Accounting for the drug life cycle and future drug prices in cost-effectiveness analysis. Pharmacoeconomics 2011; 29 (1): 1–15PubMedCrossRef Hoyle M. Accounting for the drug life cycle and future drug prices in cost-effectiveness analysis. Pharmacoeconomics 2011; 29 (1): 1–15PubMedCrossRef
36.
Zurück zum Zitat Beutels P, Van Doorslaer E, Van Damme P, et al. Methodological issues and new developments in the economic evaluation of vaccines. Expert Rev Vaccines 2003; 2 (5): 649–60PubMedCrossRef Beutels P, Van Doorslaer E, Van Damme P, et al. Methodological issues and new developments in the economic evaluation of vaccines. Expert Rev Vaccines 2003; 2 (5): 649–60PubMedCrossRef
37.
Zurück zum Zitat Edmunds WJ, Medley GF, Nokes DJ. Evaluating the costeffectiveness of vaccination programmes: a dynamic perspective. Stat Med 1999; 18 (23): 3263–82PubMedCrossRef Edmunds WJ, Medley GF, Nokes DJ. Evaluating the costeffectiveness of vaccination programmes: a dynamic perspective. Stat Med 1999; 18 (23): 3263–82PubMedCrossRef
38.
Zurück zum Zitat Davies R, Roderick P, Reaftery J. The evaluation of disease prevention and treatment using simulation models. Eur J Operational Res 2003; 150: 53–166CrossRef Davies R, Roderick P, Reaftery J. The evaluation of disease prevention and treatment using simulation models. Eur J Operational Res 2003; 150: 53–166CrossRef
39.
40.
Zurück zum Zitat Auchincloss AH, Diez Roux AV. A new tool for epidemiology: the usefulness of dynamic-agent models in understanding place effects on health. Am J Epidemiol 2008; 168 (1): 1–8PubMedCrossRef Auchincloss AH, Diez Roux AV. A new tool for epidemiology: the usefulness of dynamic-agent models in understanding place effects on health. Am J Epidemiol 2008; 168 (1): 1–8PubMedCrossRef
41.
Zurück zum Zitat Cooper K, Brailsford S, Davies R. Choice of modelling technique for evaluating health care interventions. J Operational Res Soc 2007; 58: 168–76 Cooper K, Brailsford S, Davies R. Choice of modelling technique for evaluating health care interventions. J Operational Res Soc 2007; 58: 168–76
Metadaten
Titel
Population–versus Cohort–Based Modelling Approaches
verfasst von
Dr Olivier Ethgen
Baudouin Standaert
Publikationsdatum
01.03.2012
Verlag
Springer International Publishing
Erschienen in
PharmacoEconomics / Ausgabe 3/2012
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI
https://doi.org/10.2165/11593050-000000000-00000

Weitere Artikel der Ausgabe 3/2012

PharmacoEconomics 3/2012 Zur Ausgabe

Original Research Paper

Rufinamide

Original Research Paper

Common Drug Review Recommendations