Simulation modeling: an illustrative method to estimate drug clinical and economic effectiveness (retrospective meta-analysis of anti-asthmatic therapy in children in a hospital setting)

The article presents an assessment of the clinical, economic and clinical-economic components of the basic anti-asthmatic therapy regimens in children in hospital setting. The analysis involved mathematical and statistical modeling methods, such as beta distribution, gamma distribution, Monte-Carlo simulation based on simulation of the distribution. The study material was the baseline therapy of bronchial asthma exacerbation in children in hospital setting. The study includes the pharmacotherapy data from 608 inpatient records in 2014-2015. The basic anti-asthmatic therapy in hospital setting in the analyzed period was: 1) inhalation glucocorticoid (as a monotherapy); 2) a combination of an inhalation glucocorticosteroid and a short-acting β2-agonist; 3) a combination of an inhalation glucocorticosteroid and a long-acting β2-agonist; 4) a combination of an inhalation glucocorticosteroid and a leukotriene receptor antagonist; 5) a combination of an inhalation glucocorticosteroid, a short acting β2-agonist and a leukotriene receptor antagonist; 6) a combination of a short acting β2-agonist and a leukotriene receptor antagonist. Βeta-distribution was used to calculate the clinical outcome probability, and gamma distribution was used to calculate the costs. The highest values of confidence-based clinical efficacy, calculated on the basis of beta distribution and demonstrating the probability of a positive clinical effect, are characteristic for the regimens that include a combination of an inhalation glucocorticosteroid and a leukotriene receptor antagonist, as well as an inhalation glucocorticosteroid regimen and a long-acting β2-agonist. Similarly, the average cost of treatment regimens were determined. It based on gamma distribution. The combination of the results of these two distributions for each treatment regimen on the graph allowed us to obtain a cloud of distributions that clearly illustrates the clinical and economic effectiveness of the therapy regimens analyzed when used in the population. The article presents the curves of beta distributions and a graphic representation of Monte-Carlo simulation results.