Dynamic versus static models in cost‐effectiveness analyses of anti‐viral drug therapy to mitigate an influenza pandemic

Abstract

Conventional (static) models used in health economics implicitly assume that the probability of disease exposure is constant over time and unaffected by interventions. For transmissible infectious diseases this is not realistic and another class of models is required, so-called dynamic models. This study aims to examine the differences between one dynamic and one static model, estimating the effects of therapeutic treatment with antiviral (AV) drugs during an influenza pandemic in the Netherlands. Specifically, we focus on the sensitivity of the cost-effectiveness ratios to model choice, to the assumed drug coverage, and to the value of several epidemiological factors. Therapeutic use of AV-drugs is cost-effective compared with non-intervention, irrespective of which model approach is chosen. The findings further show that: (1) the cost-effectiveness ratio according to the static model is insensitive to the size of a pandemic, whereas the ratio according to the dynamic model increases with the size of a pandemic; (2) according to the dynamic model, the cost per infection and the life-years gained per treatment are not constant but depend on the proportion of cases that are treated; and (3) the age-specific clinical attack rates affect the sensitivity of cost-effectiveness ratio to model choice.

A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings

“…It is also important to note that the model used within the analysis is static rather than dynamic, assuming that infectivity is constant over time and unaffected by the interventions. Previous studies on other infectious diseases have found robust results using both static and dynamic models (see, for example, the study by Lugnér and colleagues 228 ). However, as Lugnér and colleagues point out, although their two models both showed the intervention to be cost-effective, they did produce differing cost-effectiveness ratios and outcomes may differ depending on the cost-effectiveness threshold.…”

“…For example, within the UK the highest rates of HIV infection are reported in men who have sex with men (47 per 1000) and in the black African community (37 per 1000). 179 Interestingly, Lugnér and colleagues 228 found their dynamic model to be far more sensitive than their static model to infection attack rates, thus creating large uncertainty about future attack rates. Although their findings may be context specific, it is an area for consideration when modelling HIV prevention given the increasing use of antiretroviral therapy (in the UK 87% of people receiving care were virally suppressed and unlikely to be infectious) and the ongoing development of treatments such as the antiretroviral combination drug Truvada and the role of pre-exposure prophylaxis.…”

The cost–effectiveness of HPV vaccination in addition to screening: a Dutch perspective

“…The cost-effectiveness of HPV vaccination in addition to screening Review informahealthcare.com consequently no room for herd immunity benefits exists nor can be expected [51].…”

Mitigation of pandemic influenza: review of cost–effectiveness studies

“…We note the great impact of that one article on other papers included it in this review, either directly [14,17] or indirectly [15,[18][19][20]. The articles were evaluated and compared on various issues, including type of modeling and specific values for health-economic input variables.…”

“…Article abstracts were read and evaluated on their appropriateness for the review, and 16 articles were read in total. Of these, 12 articles were judged to adhere to the aforementioned inclusion criteria [14][15][16][17][18][19][20][21][22][23][24][25] and four were discarded from this review [26][27][28][29]. With one exception ( [22]), all reviewed articles were published in 2004 or later.…”