Developing health economic models of chronic diseases for reimbursement purposes

With an ageing population the number of chronic diseases, often requiring chronic treatment, is increasing. New health care technologies, such as drugs, diagnostics and medical devices, often provide an improvement to current standard of care. This improvement obviously comes at a certain cost. In health economics, this added benefit is weighted against the higher costs to determine whether a technology is cost-effective and in the end should be reimbursed. For that purpose, health economic models are used. This thesis deals with health-economic modelling of chronic diseases for reimbursement purposes. In the first part, various modelling approaches are discussed and applications of those approaches presented for three chronic diseases (schizophrenia, cardiovascular disease and multiple myeloma). The second part is on model parameter estimations in terms of (i) incorporating compliance and (ii) various methods of incorporating categorical inputs in health economic models. Finally, the issue of identifying variables (including health economic outcomes), that are predictive for reimbursement decisions in Scotland, is addressed.