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
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 Baye...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-08-01
|
Series: | Cost Effectiveness and Resource Allocation |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12962-020-00224-w |
id |
doaj-9a77fd4ebafc473196f2fb9ff5f76f60 |
---|---|
record_format |
Article |
spelling |
doaj-9a77fd4ebafc473196f2fb9ff5f76f602020-11-25T03:01:30ZengBMCCost Effectiveness and Resource Allocation1478-75472020-08-011811910.1186/s12962-020-00224-wUsing 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 cariprazineZoltán Vokó0István Bitter1Beatrix Mersich2János Réthelyi3Anett Molnár4János G. Pitter5Árpád Götze6Margit Horváth7Kristóf Kóczián8Laura Fonticoli9Filippo Lelli10Bertalan Németh11Center for Health Technology Assessment, Semmelweis UniversityDepartment of Psychiatry and Psychotherapy, Semmelweis UniversityDepartment of Psychiatry and Psychotherapy, Semmelweis UniversityDepartment of Psychiatry and Psychotherapy, Semmelweis UniversitySyreon Research InstituteSyreon Research InstituteRichter Gedeon PlcRichter Gedeon PlcRichter Gedeon PlcRecordati S.P.ARecordati S.P.ASyreon Research InstituteAbstract 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 treatment-specific 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). Conclusions Imputing zeros to missing transition probabilities in Markov models might be untenable from the clinical perspective and may result in inappropriate estimates. Bayesian statistics provides an appropriate framework for imputing missing values without making overly simple assumptions. Informative priors based on expert opinions might be more appropriate than vague priors.http://link.springer.com/article/10.1186/s12962-020-00224-wBayesian statisticsTransition probabilitiesMarkov modelSchizophrenia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Zoltán Vokó István Bitter Beatrix Mersich János Réthelyi Anett Molnár János G. Pitter Árpád Götze Margit Horváth Kristóf Kóczián Laura Fonticoli Filippo Lelli Bertalan Németh |
spellingShingle |
Zoltán Vokó István Bitter Beatrix Mersich János Réthelyi Anett Molnár János G. Pitter Árpád Götze Margit Horváth Kristóf Kóczián Laura Fonticoli Filippo Lelli Bertalan Németh 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 Cost Effectiveness and Resource Allocation Bayesian statistics Transition probabilities Markov model Schizophrenia |
author_facet |
Zoltán Vokó István Bitter Beatrix Mersich János Réthelyi Anett Molnár János G. Pitter Árpád Götze Margit Horváth Kristóf Kóczián Laura Fonticoli Filippo Lelli Bertalan Németh |
author_sort |
Zoltán Vokó |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
BMC |
series |
Cost Effectiveness and Resource Allocation |
issn |
1478-7547 |
publishDate |
2020-08-01 |
description |
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 treatment-specific 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). Conclusions Imputing zeros to missing transition probabilities in Markov models might be untenable from the clinical perspective and may result in inappropriate estimates. Bayesian statistics provides an appropriate framework for imputing missing values without making overly simple assumptions. Informative priors based on expert opinions might be more appropriate than vague priors. |
topic |
Bayesian statistics Transition probabilities Markov model Schizophrenia |
url |
http://link.springer.com/article/10.1186/s12962-020-00224-w |
work_keys_str_mv |
AT zoltanvoko usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT istvanbitter usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT beatrixmersich usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT janosrethelyi usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT anettmolnar usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT janosgpitter usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT arpadgotze usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT margithorvath usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT kristofkoczian usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT laurafonticoli usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT filippolelli usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine AT bertalannemeth usinginformativepriorbasedonexpertopinioninbayesianestimationofthetransitionprobabilitymatrixinmarkovmodellinganexamplefromthecosteffectivenessanalysisofthetreatmentofpatientswithpredominantlynegativesymptomsofschizophreniawithcariprazine |
_version_ |
1724693492837384192 |