Page 83 - Htain Manual

Decision Model 2: Markov Model

In this, we describe an example of a cost-effectiveness analysis which was used to

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evaluate sorafenib – a drug used to treat hepatocellular carcinoma (HCC) . HCC is a primary
malignant neoplasm of the liver. The majority (70%) of cases of HCC in India present at

advanced stage (Barcelona Clinic Liver Cancer (BCLC) stage C and D) in which curative

resection is not possible. For these unresectable, advanced HCC cases with extra-hepatic

spread or vascular invasion, treatment options are limited. Targeted molecular therapy –

sorafenib, is indicated for advanced BCLC stage C patients of HCC. Sorafenib has been
reported to result in an increased median overall survival and time to progression in advanced

HCC as compared to Best Supportive Care (BSC). The alternative to giving sorafenib is BSC

which comprises of standard routine care and complications management. Sorafenib and BSC
arms are considered as intervention and control respectively. In order to model life-term costs

and consequences, patients are segregated into two alive health transition states termed as

Progression Free State (PFS) and Progressive Disease (PD) in intervention and control arm

respectively. As shown in the Figure 3, HCC patients diagnosed in PFS health state can advance

to PD or Death from all-cause mortality health states. Death from HCC happens from PD
health state only.

Figure 3: Markov Model structure

Figure 3 is next converted to Table 3 and 4 which show a transition matrices which

represents the probability of moving from each health state to the next state in sorafenib

and BSC arm respectively.

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