Use this URL to cite or link to this record in EThOS:
Title: Pharmacologically-based mechanistic modelling in health economic evaluation
Author: Pink, Joshua
Awarding Body: Prifysgol Bangor University
Current Institution: Bangor University
Date of Award: 2012
Availability of Full Text:
Access from EThOS:
Access from Institution:
This thesis concerns the linking together of the currently distinct teclmiques of pharmacokinetic-pharmacodynamic and health economic modelling. These have limitations, with economic models being empirical and thus hard to extrapolate outside the evidence base where they are constructed, and challenging to implement early in the drug development process. Pharmacokinetic-pharmacodynamic models, by contrast, are mechanistic but produce a limited range of outputs, not generating all the values useful to infonn decision making. Pharmacokinetic-pharmacodynamic-pharmacoeconomic models, by linking these approaches, have the potential to overcome these limitations. The feasibility, validity and applicability of such an approach are assessed through two case studies. The first contains both retrospective and prospective simulations ofrituximab for the treatment of follicular lymphoma. Retrospective analyses allow simulated results to be compared with trial-based data, and show an acceptable degree of concordance between the two methods. The prospective simulation of a trial currently recruiting will enable comparisons with the results of the trial, when these become available. The second and larger case study uses anticoagulation and stroke prophylaxis for patients with atrial fibrillation as an example. The end result is a full, prospective simulation of genotype dosed warfarin compared with both standard clinical dosing and a number of newly available oral anticoagulants. To make such an analysis possible, necessary prerequisite work was undertaken with the construction of a discrete event simulation to extrapolate both trial and simulation results to a lifetime horizon and an indirect comparison of all available treatments, to ensure all possible alternatives are considered in the analysis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available