The effect of model selection on cost-effectiveness research: a comparison of kidney function-based microsimulation and disease grade-based microsimulation in chronic kidney disease modeling

Shusuke Hiragi; Hiroshi Tamura; Rei Goto; Tomohiro Kuroda

doi:10.1186/s12911-018-0678-7

The effect of model selection on cost-effectiveness research: a comparison of kidney function-based microsimulation and disease grade-based microsimulation in chronic kidney disease modeling

BMC Med Inform Decis Mak. 2018 Nov 9;18(1):94. doi: 10.1186/s12911-018-0678-7.

Authors

Shusuke Hiragi^{1

2}, Hiroshi Tamura³, Rei Goto^{4

5}, Tomohiro Kuroda³

Affiliations

¹ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. hiragi.shusuke.4x@kyoto-u.ac.jp.
² Department of Nephrology, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. hiragi.shusuke.4x@kyoto-u.ac.jp.
³ Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
⁴ Graduate School of Business Administration, Keio University, 2-33-28 Hiyoshi Honcho, Kohoku-ku, Yokohama, Kanagawa, 223-8526, Japan.
⁵ Keio Business School, Keio University, 2-33-28 Hiyoshi Honcho, Kohoku-ku, Yokohama, Kanagawa, 223-8526, Japan.

Abstract

Background: Cost effectiveness research is emerging in the chronic kidney disease (CKD) research field. Especially, an individual-level state transition model (microsimulation) is widely used for these researches. Some researchers set CKD grades as discrete health states, and the transition probabilities between these states were dependent on the CKD grades (disease grade-based microsimulation, MSM-dg), while others set estimated glomerular filtration rate value which determines the severity of CKD as a main variable describing patients' continuous status (kidney function-based microsimulation, MSM-kf). MSM-kf seems to reflect the real world more precisely but is more difficult to implement. We compared the calculation results of these two microsimulation models to evaluate the effect of model selection on CKD cost-effectiveness analysis.

Methods: We implemented simplified MSM-dg and MSM-kf emulating natural course of CKD in general, and compared models using parameters derived from an IgA nephropathy cohort. After checking these models' overall behavior, life-years, utilities, and thresholds regarding intervention costs below which the intervention is thought as dominant (V0) or cost-effective (V1) were calculated. In addition, one-way and probabilistic sensitivity analyses were performed.

Results: With base-case parameters, the calculated life-years was shorter in MSM-dg (73.89 vs. 75.80 years) while the thresholds were almost equal (86.87 vs. 90.43 (V0), 132.29 vs. 146.25 [V1 in 1000 USD]) compared to MSM-kf. Sensitivity analyses showed a tendency of the MSM-dg to show shorter results in life-years. V0 and V1 were distributed by approximately ±100,000 USD (V0) and ± 150,000 USD (V1) between models.

Conclusions: Estimated cost-effectiveness thresholds by both models were not the same and its difference distributed too wide to be ignored. This result indicated that model selection in CKD cost-effectiveness research has large effect on their conclusions.

Keywords: Chronic kidney disease; Cost effectiveness analysis; Disease modeling; Health economics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomedical Research
Computer Simulation*
Cost-Benefit Analysis
Disease Progression
Glomerular Filtration Rate / physiology
Humans
Models, Biological*
Renal Insufficiency, Chronic / complications
Renal Insufficiency, Chronic / mortality*
Renal Insufficiency, Chronic / physiopathology*
Sensitivity and Specificity