Multistate Statistical Modeling: A Tool to Build a Lung Cancer Microsimulation Model That Includes Parameter Uncertainty and Patient Heterogeneity

Medical Decision Making : an International Journal of the Society for Medical Decision Making
Mathilda L BongersV M H Coupé

Abstract

With the shift toward individualized treatment, cost-effectiveness models need to incorporate patient and tumor characteristics that may be relevant to treatment planning. In this study, we used multistate statistical modeling to inform a microsimulation model for cost-effectiveness analysis of individualized radiotherapy in lung cancer. The model tracks clinical events over time and takes patient and tumor features into account. Four clinical states were included in the model: alive without progression, local recurrence, metastasis, and death. Individual patients were simulated by repeatedly sampling a patient profile, consisting of patient and tumor characteristics. The transitioning of patients between the health states is governed by personalized time-dependent hazard rates, which were obtained from multistate statistical modeling (MSSM). The model simulations for both the individualized and conventional radiotherapy strategies demonstrated internal and external validity. Therefore, MSSM is a useful technique for obtaining the correlated individualized transition rates that are required for the quantification of a microsimulation model. Moreover, we have used the hazard ratios, their 95% confidence intervals, and their cova...Continue Reading

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Citations

Oct 5, 2016·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Claire WilliamsAndrew H Briggs
Nov 11, 2017·International Journal of Technology Assessment in Health Care·Mathilda L BongersVeerle M H Coupé
May 28, 2020·The European Journal of Health Economics : HEPAC : Health Economics in Prevention and Care·Gabrielle JongeneelVeerle M H Coupé
Mar 14, 2018·Breast Cancer : Basic and Clinical Research·Igor MotuzyukYevhenii Kostiuchenko
Nov 30, 2020·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Beth S WoodsMarta Soares

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Software Mentioned

mstate package for MSSM
MSSM
R
Excel
mstate
Visual Basic

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