An Introductory Tutorial on Cohort State-Transition Models in R Using a Cost-Effectiveness Analysis Example

Fernando Alarid-Escudero, Eline Krijkamp, Eva A. Enns, Alan Yang, M. G. Myriam Hunink, Petros Pechlivanoglou and Hawre Jalal
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Fernando Alarid-Escudero: Division of Public Administration, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Aguascalientes, Mexico
Eline Krijkamp: Department of Epidemiology and Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
Eva A. Enns: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
Alan Yang: The Hospital for Sick Children, Toronto, Ontario, Canada
M. G. Myriam Hunink: Department of Epidemiology and Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
Petros Pechlivanoglou: The Hospital for Sick Children, Toronto and University of Toronto, Toronto, Ontario, Canada
Hawre Jalal: School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

Medical Decision Making, 2023, vol. 43, issue 1, 3-20

Abstract: Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. A cohort state-transition model (cSTM) is a decision model commonly used in medical decision making to simulate the transitions of a hypothetical cohort among various health states over time. This tutorial focuses on time-independent cSTM, in which transition probabilities among health states remain constant over time. We implement time-independent cSTM in R, an open-source mathematical and statistical programming language. We illustrate time-independent cSTMs using a previously published decision model, calculate costs and effectiveness outcomes, and conduct a cost-effectiveness analysis of multiple strategies, including a probabilistic sensitivity analysis. We provide open-source code in R to facilitate wider adoption. In a second, more advanced tutorial, we illustrate time-dependent cSTMs.

Keywords: cohort state-transition models; cost-effectiveness analysis; Markov models; R software; tutorial (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:43:y:2023:i:1:p:3-20

DOI: 10.1177/0272989X221103163

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