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Comparing the Cohort and Micro-Simulation Modeling Approaches in Cost-Effectiveness Modeling of Type 2 Diabetes Mellitus: A Case Study of the IHE Diabetes Cohort Model and the Economics and Health Outcomes Model of T2DM

Author

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  • Michael Willis

    (The Swedish Institute for Health Economics)

  • Adam Fridhammar

    (The Swedish Institute for Health Economics)

  • Jens Gundgaard

    (Novo Nordisk A/S)

  • Andreas Nilsson

    (The Swedish Institute for Health Economics)

  • Pierre Johansen

    (Novo Nordisk A/S)

Abstract

Background Economic modeling is widely used in estimating cost-effectiveness in type 2 diabetes mellitus. Because type 2 diabetes is complex and patients are heterogenous, the cohort modeling approach may generate biased estimates of costeffectiveness. The IHE Diabetes Cohort Model (IHE-DCM) was constructed using the cohort approach as an alternative for stakeholders with limited resources, some of whom have voiced reasonable concerns about a lack of transparency with type 2 diabetes micro-simulation models and long run times. Objectives The objective of this study was to inform decision makers by investigating the direction and magnitude of bias of IHE-DCM cost-effectiveness estimates that can be attributed to the cohort modeling approach. Methods Simulation scenarios inspired by the 9th Mount Hood Diabetes Challenge were simulated with IHE-DCM and with a micro-simulation model, the Economic and Health Outcomes Model of T2DM (ECHO-T2DM), and key metrics (absolute and incremental costs and quality-adjusted life-years, event rates, and cost-effectiveness) were compared for evidence of systematic differences. The models were harmonized to the extent possible to ensure that differences were driven primarily by the unit of observation and not by other model differences. Results IHE-DCM run times were faster and IHE-DCM produced uniformly larger estimates of absolute life-years, quality-adjusted life-years, and costs than ECHO-T2DM but smaller between-arm (incremental) differences. Estimated incremental cost-effectiveness ratios and net monetary benefits varied similarly and predictably across the scenarios. On average, IHE-DCM estimates of incremental cost-effectiveness ratios and net monetary benefits were CAN$269 (3%) and CAN$2935 (10%) smaller, respectively, than ECHO-T2DM. Conclusions There was little evidence that estimated cost-effectiveness metrics, the outcomes that matter most to stakeholders, differed systematically.

Suggested Citation

  • Michael Willis & Adam Fridhammar & Jens Gundgaard & Andreas Nilsson & Pierre Johansen, 2020. "Comparing the Cohort and Micro-Simulation Modeling Approaches in Cost-Effectiveness Modeling of Type 2 Diabetes Mellitus: A Case Study of the IHE Diabetes Cohort Model and the Economics and Health Out," PharmacoEconomics, Springer, vol. 38(9), pages 953-969, September.
  • Handle: RePEc:spr:pharme:v:38:y:2020:i:9:d:10.1007_s40273-020-00922-6
    DOI: 10.1007/s40273-020-00922-6
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    References listed on IDEAS

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    1. Adrian Bagust & Sophie Beale, 2005. "Modelling EuroQol health‐related utility values for diabetic complications from CODE‐2 data," Health Economics, John Wiley & Sons, Ltd., vol. 14(3), pages 217-230, March.
    2. Pierre Johansen & Jonas Håkan-Bloch & Aiden R. Liu & Peter G. Bech & Sofie Persson & Lawrence A. Leiter, 2019. "Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada," PharmacoEconomics - Open, Springer, vol. 3(4), pages 537-550, December.
    3. Adam Lundqvist & Katarina Steen Carlsson & Pierre Johansen & Emelie Andersson & Michael Willis, 2014. "Validation of the IHE Cohort Model of Type 2 Diabetes and the Impact of Choice of Macrovascular Risk Equations," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-12, October.
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    1. Rita Faria’s journal round-up for 14th September 2020
      by Rita Faria in The Academic Health Economists' Blog on 2020-09-14 11:00:07

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