ArticlePharmacoEconomics2026
Comparing the Influence of Heterogeneity on Model Outcomes in Individual-Level and Cohort Simulations: An Exploratory Simulation Study.
Article in PharmacoEconomics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- Matricellular Proteins in Bladder Cancer: Context-Dependent Roles in Tumor Promotion and Suppression.International journal of molecular sciences · 2026Review
- Lowering the Barriers to the Appropriate Use of Individual-Level Simulation for Health Economic Evaluation.PharmacoEconomics · 2026Article
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Authors and funding
3 authors.
Funding
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Abstract
introductionWhen developing health economic simulation models, individual-level and cohort state-transition model types are commonly used. However, heterogeneity and the extent to which it is taken into account is thought to affect simulation outcomes differently in individual-level and cohort simulations, even when model structures are identical.
objectiveThis study aimed to investigate the conditions under which the use of different model types may lead to different outcomes and therefore potentially different policy decisions.
methodsA microsimulation model was used to reflect an individual-level simulation, simulating patient characteristics and, artificially, a cohort-level simulation of identical patients, using the exact same model structure. Four scenarios were analyzed: heterogeneity in age (scenario 1) influencing progression and recovery probabilities when on treatment, heterogeneity in sex (scenario 2) influencing progression and recovery probabilities when on treatment, combined heterogeneity in age and sex (scenario 3) influencing progression and recovery probabilities when on treatment, and heterogeneity in age when including age-dependent all-cause mortality (scenario 4). In every scenario, heterogeneity impact was varied, and health state occupancy, incremental costs, incremental effects, and the net monetary benefit of treatment versus no treatment were compared between the individual-level and cohort simulations.
resultsWhen introducing heterogeneity in age, sex, and age and sex combined, all scenarios showed differences between outcomes of individual-level and cohort simulations. However, these differences did not change the cost-effectiveness conclusions. When age influenced only age-dependent mortality, there were differences between the outcomes for the individual-level and cohort simulations when heterogeneity in age was introduced.
conclusionPatient heterogeneity can affect the outcomes of individual and cohort simulations differently, but reflecting more heterogeneity does not necessarily increase differences in simulation outcomes. However, age-dependent mortality affected analytic outcomes differently, suggesting a need for caution when developing cohort models if age is heterogeneous.
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