Modeling cost-effectiveness analysis of treatment sequencing

In clinical practice, patients with cancer often undergo treatment with a sequence of drugs, usually because of diminishing effectiveness over time or resistance development. However, few cost-effectiveness analyses have included that fact in their model. This paper aims at closing that gap by presenting a model that reflects the possibility of the patient switching from one therapeutic agent to another one throughout the long-term duration of his/her life. • Long-term diseases, like cancer, often need treatments with a sequence of drugs. • Markov model to assist physicians in choosing the best sequence of therapeutical agents. • Four non-absorbing states replicated with an index plus the absorbing state Death. • Cost-effectiveness analysis to evaluate the different possible sequences. • Application to the evaluation of different treatment pathways for relapsed ovarian cancer.