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Multistate Statistical Modeling

Author

Listed:
  • Mathilda L. Bongers
  • Dirk de Ruysscher
  • Cary Oberije
  • Philippe Lambin
  • Carin A. Uyl–de Groot
  • V. 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 covariance to quantify the parameter uncertainty of the model in a correlated way. The obtained model will be used to evaluate the cost-effectiveness of individualized radiotherapy treatment planning, including the uncertainty of input parameters. We discuss the model-building process and the strengths and weaknesses of using MSSM in a microsimulation model for individualized radiotherapy in lung cancer.

Suggested Citation

  • Mathilda L. Bongers & Dirk de Ruysscher & Cary Oberije & Philippe Lambin & Carin A. Uyl–de Groot & V. M. H. Coupé, 2016. "Multistate Statistical Modeling," Medical Decision Making, , vol. 36(1), pages 86-100, January.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:1:p:86-100
    DOI: 10.1177/0272989X15574500
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
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    Cited by:

    1. Gabrielle Jongeneel & Marjolein J. E. Greuter & Felice N. Erning & Miriam Koopman & Jan P. Medema & Raju Kandimalla & Ajay Goel & Luis Bujanda & Gerrit A. Meijer & Remond J. A. Fijneman & Martijn G. H, 2020. "Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(7), pages 1059-1073, September.
    2. Stavroula A Chrysanthopoulou, 2017. "MILC: A Microsimulation Model of the Natural History of Lung Cancer," International Journal of Microsimulation, International Microsimulation Association, vol. 10(3), pages 5-26.

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