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Markov Models: Overview: Gerald F. Kominski, PH.D
Markov Models: Overview: Gerald F. Kominski, PH.D
Markov Models: Overview: Gerald F. Kominski, PH.D
p11=0.7
Well
p12=0.2 p13=0.1
p22=0.9
Post- Dead
Stroke p23=0.1
p33=1.0
The probabilities for all paths out of a state must sum to 1.0.
Dead
Defining a Markov Model
The data in the last column is used to produce a survival curve, aka a Markov trace.
Estimating Markov Models:
Monte Carlo Simulation
Instead of processing an entire cohort and applying
probabilities to the cohort, simulate a large number
(e.g., 10,000) cases proceeding through the transition
matrix
- Monte Carlo simulation
- TreeAge will do this for you quickly, without programming
The advantage of this approach is that it provides
estimates of variation around the mean
Monte Carlo simulation is most valuable because it
permits efficient modeling of complex prior history
- Such variables are known as tracker variables
Example of a 5-State Markov
Source: Kominski GF, Varon SF, Morisky DE, Malotte CK, Ebin VJ, Coly A, Chiao C. Costs and cost-
effectiveness of adolescent compliance with treatment for latent tuberculosis infection: results from a randomized
trial. Journal of Adolescent Health 2007;40(1):61-68.
Key Assumptions of the Markov Model
Variable Value (Range) Reference
Efficacy of IPT 0.85 (0.75-0.98) 19
Cost of treating active TB $22,500 ($17,000-$30,000) 17
Cost of IPT Varies by study group and whether 6-month Current study
IPT is completed
TB cases per 100,000 250 (120-560) 20
TB case fatality rate 0.0045-0.16 (varies with age) 17
All-cause mortality rate per 19-15,476 (varies with age) National Center for Health
100,000 Statistics, 1999 mortality tables
Hepatotoxicity of IPT 0.0008 (age<35, started IPT) 21
0.0012 (age<35, completed IPT)
Hepatitis fatality rate 0.002 21
Cost of treating IPT-induced $11,250 ($8,500-$15,000) Authors assumption
hepatitis
QALY Healthy 1.00 (0.95-1.00) Authors assumption
QALY Positive Skin Test, but
Incomplete IPT 0.90 (0.80-0.95) Authors assumption
QALY Active TB 0.50 (0.20-0.90) Harvard Center for Risk Analysis
QALY IPT-induced hepatitis 0.75 (75-0.90) Harvard Center for Risk Analysis