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DecisionAnalysis,ModelingandHealth-HERC
M To Healthy To Sick To Dead Sick Tx Ineffective - To Sick To Sick Tx Effective -To Healthy T+ T- = No Tx = To Healthy T- = No Tx = Intervention Cohorts vs. individualsDeterministic vs. stochastic Markov cohort model (i.e., the matrix version) is smooth model (infinite population size) of the proportion of a cohort in each state at each time Can use same structure to simulate many individuals (first-order Monte Carlo) (simple microsimulation) The matrix becomes the probability of an individual transition from one state to another instead of the % of those in a given state who deterministically flow into another state Microsimulation Healthy Sick Dead 0 1 2 3 4 5 Microsimulation Healthy Sick Dead 0 1 2 3 4 5 pHS pSS pSH pHS pSD Microsimulation Healthy Sick Dead 0 1 2 3 4 5 Microsimulation Healthy Sick Dead 0 1 2 3 4 5 Recall the trace and calculation of outcomes from it Stage propH_t propS_t propD_t NotD 0 1.00 0.00 0.00 1.00 1 0.90 0.09 0.01 0.99 2 0.75 0.10 0.15 0.85 3 0.50 0.25 0.25 0.75 4 0.20 0.40 0.40 0.60 5 0.10 0.30 0.60 0.40 6 0.05 0.15 0.80 0.20 7 0.00 0.00 1.00 0.00 Microsimulation Run with many individuals Calculate proportions in each state at each time (just like in our Markov cohort table) Stage 2: 5100 sick / 100,000 people = 5.1% Approximates the “smooth” cohort version 5.1% [CI] is ~= 5.0% in “smooth” cohort Advanced Larger the number of individuals the closer to the smooth cohort (tighter the CI) See Kuntz/Weinstein chapter of Michael Drummond’s book on Economic Evaluation for more on this for more on this Why consider microsimulation? It requires longer simulation times It is more complex Fewer people are familiar with it There is “Monte Carlo” noise (random error) even with simulating fairly large groups of individuals (at least for rare events) State explosion! Suppose you want to use a Markov model of a disease with 2 states and death (H,S,D) Suppose you need it stratified by sex and smoking status (3 levels), BMI (4 levels), hypertension (4
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