Using informative prior based on expert opinion in Bayesian estimation of the transition probability matrix in Markov mo
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ost Effectiveness and Resource Allocation Open Access
METHODOLOGY
Using informative prior based on expert opinion in Bayesian estimation of the transition probability matrix in Markov modelling—an example from the cost‑effectiveness analysis of the treatment of patients with predominantly negative symptoms of schizophrenia with cariprazine Zoltán Vokó1,2* , István Bitter3, Beatrix Mersich3, János Réthelyi3, Anett Molnár2, János G. Pitter2, Árpád Götze4, Margit Horváth4, Kristóf Kóczián4, Laura Fonticoli5, Filippo Lelli5 and Bertalan Németh2
Abstract Background: When patient health state transition evidence is missing from clinical literature, analysts are inclined to make simple assumptions to complete the transition matrices within a health economic model. Our aim was to provide a solution for estimating transition matrices by the Bayesian statistical method within a health economic model when empirical evidence is lacking. Methods: We used a previously published cost-effectiveness analysis of the use of cariprazine compared to that of risperidone in patients with predominantly negative symptoms of schizophrenia. We generated the treatmentspecific state transition probability matrices in three different ways: (1) based only on the observed clinical trial data; (2) based on Bayesian estimation where prior transition probabilities came from experts’ opinions; and (3) based on Bayesian estimation with vague prior transition probabilities (i.e., assigning equal prior probabilities to the missing transitions from one state to the others). For the second approach, we elicited Dirichlet prior distributions by three clinical experts. We compared the transition probability matrices and the incremental quality-adjusted life years (QALYs) across the three approaches. Results: The estimates of the prior transition probabilities from the experts were feasible to obtain and showed considerable consistency with the clinical trial data. As expected, the estimated health benefit of the treatments was different when only the clinical trial data were considered (QALY difference 0.0260), its combination with the experts’ beliefs were used in the economic model (QALY difference 0.0253), and when vague prior distributions were used (QALY difference 0.0243).
*Correspondence: voko.zoltan@semmelweis‑univ.hu 1 Center for Health Technology Assessment, Semmelweis University, Üllői út 25, 1091 Budapest, Hungary Full list of author information is available at the end of the article © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not in
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