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Health Economic Evaluation Using Markov Models in R for Microsoft Excel Users: A Tutorial

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Abstract

A health economic evaluation (HEE) is a comparative analysis of alternative courses of action in terms of both costs and consequences. A cost-effectiveness analysis is a type of HEE that compares an intervention to one or more alternatives by estimating how much it costs to gain an additional unit of health outcome. Cost-effectiveness analyses are commonly performed using Microsoft (MS) Excel. However, there is current interest in using other software that is better suited to more complex problems, methods, and data, as well as improved reproducibility and transparency. That is, it is increasingly important to be able to repeat an analysis of a particular data set and obtain the same results, and access the analysis and results in a clear and comprehensive openly available form. In this tutorial we provide a step-by-step guide on how to implement a mainstay model of HEE, namely a Markov model, in the statistical programming language R. The adoption of R for the purpose of cost-effectiveness analysis is highly dependent on the ability of the health economic modeller to understand, learn, and apply programming-type skills. R is likely to be less familiar than MS Excel for many modellers and so coding a cost-effectiveness model in R can be a large jump. We describe the technical details from the perspective of a MS Excel user to help bridge the gap between software and reduce the learning curve by providing for the first-time side-by-side comparisons of the Markov model example in MS Excel and R.

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Author information

Author notes

  1. Nathan Green, Felicity Lamrock have joint first author.

Authors and Affiliations

  1. Department of Statistical Science, University College London, London, UK

    Nathan Green

  2. Mathematical Sciences Research Centre, Queen’s University Belfast, Belfast, Northern Ireland, UK

    Felicity Lamrock

  3. HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London, UK

    Nichola Naylor

  4. Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK

    Nichola Naylor, Jack Williams & Andrew Briggs

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  1. Nathan Green
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  2. Felicity Lamrock
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  3. Nichola Naylor
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  4. Jack Williams
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  5. Andrew Briggs
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Corresponding author

Correspondence to Felicity Lamrock.

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Funding

Financial support for this study was provided by a Medical Research Council Centre pump-priming award. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The views expressed are those of the author(s) and are not necessarily those of author-affiliated institutions, including the National Institute for Health Research, the UK Health Security Agency or the Department of Health and Social Care.

Competing interests

The authors declare they have no conflicts of interest.

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Not applicable.

Data availability

All data used for this tutorial paper are available at https://github.com/Excel-R-tutorials/Markov-model-introduction

Code availability

Code for the R model used in this tutorial can be found on GitHub at the following link https://github.com/Excel-R-tutorials/Markov_Intro. The corresponding original MS Excel model is available open-access and can be downloaded from the following link https://doi.org/10.17037/DATA.00002980 [20].

Authorship statement

N. Green: Conceptualisation, writing original draft, validation, writing review and editing. F. Lamrock: Conceptualisation, writing original draft, validation, writing review and editing. N. Naylor: validation, writing review and editing. J. Williams: validation, writing review and editing. A. Briggs: Resources, writing review and editing.

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Green, N., Lamrock, F., Naylor, N. et al. Health Economic Evaluation Using Markov Models in R for Microsoft Excel Users: A Tutorial. PharmacoEconomics 41, 5–19 (2023). https://doi.org/10.1007/s40273-022-01199-7

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