Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Markov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>As neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.</jats:p></jats:sec>

Robotics and Artificial Intelligence in Endovascular Neurosurgery

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Incorporating economic analysis in interventional cardiology research

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