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A Flexible Open-Source Decision Model for Value Assessment of Biologic Treatment for Rheumatoid Arthritis


Incerti D1, Curtis JR2, Shafrin J1, Lakdawalla DN3, Jansen JP4,5. Pharmacoeconomics. 2019 Feb 9. doi: 10.1007/s40273-018-00765-2. [Epub ahead of print]

Author Information

1 Innovation and Value Initiative, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA, 90025, USA.

2 Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.

3 Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.

4 Innovation and Value Initiative, 11100 Santa Monica Boulevard, Suite 500, Los Angeles, CA, 90025, USA. jeroen.jansen@thevalueinitiative.org.

5 Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA. jeroen.jansen@thevalueinitiative.org.



The nature of model-based cost-effectiveness analysis can lead to disputes in the scientific community. We propose an iterative and collaborative approach to model development by presenting a flexible open-source simulation model for rheumatoid arthritis (RA), accessible to both technical and non-technical end-users.


The RA model is a discrete-time individual patient simulation with 6-month cycles. Model input parameters were estimated based on currently available evidence and treatment effects were obtained with Bayesian network meta-analysis techniques. The model contains 384 possible model structures informed by previously published models. The model consists of the following components: (i) modifiable R and C++ source code available in a GitHub repository; (ii) an R package to run the model for custom analyses; (iii) detailed model documentation; (iv) a web-based user interface for full control over the model without the need to be well-versed in the programming languages; and (v) a general audience web-application allowing those who are not experts in modeling or health economics to interact with the model and contribute to value assessment discussions.


A primary function of the initial version of RA model is to help understand and quantify the impact of parameter uncertainty (with probabilistic sensitivity analysis), structural uncertainty (with multiple competing model structures), the decision framework (cost-effectiveness analysis or multi-criteria decision analysis), and perspective (healthcare or limited societal) on estimates of value.


In order for a decision model to remain relevant over time it needs to evolve along with its supporting body of clinical evidence and scientific insight. Multiple clinical and methodological experts can modify or contribute to the RA model at any time due to its open-source nature.