The FAD for boceprevir (Merck Sharp and Dohme) for the treatment of genotype 1 chronic hepatitis C was recently published with it being made an option option for the treatment. However, a major exclusion from the manufacturer’s submission was transmission of hepatitis C. Why would a manufacturer not include this? For zero cost, a drug is legitimately shown to be more cost-effective (or alternatively, could be shown to justify a higher price). Strange.
Complexity of transmission modelling is often cited. When transmission includes a spatial dimension, for example, with influenza or MRSA, complexity can be an issue. Although even this can be overcome, for example, Yang Meng (HEDS) produced an agent-based model to examine different strategies to combat MRSA (Meng Y, et al. An application of agent-based simulation to the management of hospital-acquired infection. Journal of Simulation 2010; 4:60–67).
For boceprevir, the lack of transmission modelling is made even more puzzling, when a model of tranmission has already been published! What will Janssen do in their submission to NICE for telaprevir?
Our only explantion for this is that many research organisations and manufactuers have a fixed mindset of using simple markov models, without the knowledge or experience of more complex modelling methodologies such as compartmental models, discrete event simulations or agent-based models. If so, they should consider doing our MSc Health Economics and Decision Modelling and learn about them.
