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You Only Die Once: Accounting for Multi-Attributable Mortality Risks in Multi-Disease Models for Health-Economic Analyses

Author

Listed:
  • Rudolf T. Hoogenveen
  • Hendriek C. Boshuizen
  • Peter M. Engelfriet
  • Pieter H. M. van Baal

Abstract

Mortality rates in Markov models, as used in health economic studies, are often estimated from summary statistics that allow limited adjustment for confounders. If interventions are targeted at multiple diseases and/or risk factors, these mortality rates need to be combined in a single model. This requires them to be mutually adjusted to avoid ‘double counting’ of mortality. We present a mathematical modeling approach to describe the joint effect of mutually dependent risk factors and chronic diseases on mortality in a consistent manner. Most importantly, this approach explicitly allows the use of readily available external data sources. An additional advantage is that existing models can be smoothly expanded to encompass more diseases/risk factors. To illustrate the usefulness of this method and how it should be implemented, we present a health economic model that links risk factors for diseases to mortality from these diseases, and describe the causal chain running from these risk factors (e.g., obesity) through to the occurrence of disease (e.g., diabetes, CVD) and death. Our results suggest that these adjustment procedures may have a large impact on estimated mortality rates. An improper adjustment of the mortality rates could result in an underestimation of disease prevalence and, therefore, disease costs.

Suggested Citation

  • Rudolf T. Hoogenveen & Hendriek C. Boshuizen & Peter M. Engelfriet & Pieter H. M. van Baal, 2017. "You Only Die Once: Accounting for Multi-Attributable Mortality Risks in Multi-Disease Models for Health-Economic Analyses," Medical Decision Making, , vol. 37(4), pages 403-414, May.
    • Handle: RePEc:sae:medema:v:37:y:2017:i:4:p:403-414
    DOI: 10.1177/0272989X16658661
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    References listed on IDEAS

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    1. Asaria, Miqdad & Walker, Simon & Palmer, Stephen & Gale, Chris P & Shah, Anoop D & Abrams, Keith R & Crowther, Michael & Manca, Andrea & Timmis, Adam & Hemingway, Harry & Sculpher, Mark, 2016. "Using electronic health records to predict costs and outcomes in stable coronary artery disease," LSE Research Online Documents on Economics 101257, London School of Economics and Political Science, LSE Library.
    2. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    3. Pieter H M van Baal & Johan J Polder & G Ardine de Wit & Rudolf T Hoogenveen & Talitha L Feenstra & Hendriek C Boshuizen & Peter M Engelfriet & Werner B F Brouwer, 2008. "Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure," PLOS Medicine, Public Library of Science, vol. 5(2), pages 1-8, February.
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