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Multiple cohort models, also known as dynamic population models, are used to represent the whole women population that have been invited to the program during the study period whereas single cohort models are useful to conclude lifetime effects in a woman with specific characteristics.
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Future work will explicitly evaluate the cost-effectiveness of changes to the screening program in the context of vaccination, using multiple cohort modelling methods.
The use of a multiple cohort model allowed consideration of the diseconomies associated with using a costly, capital intensive second or third line treatment by simulating the purchasing of new equipment as required over the time horizon and avoided bias inherent in the allocation of capital costs across the whole population and time period using a single cohort technique.
We chose a multiple cohort design to better model the effects of applying sequences of escalating treatment and where progressively fewer members of a cohort would need additional surgery.
Second, cohort models become very complex if they need to capture multiple co-morbidities, such as those associated with alcohol misuse, which has been linked with multiple health problems.
In accordance with standard practice for health economic evaluation of the incremental costs and effects of new strategies, we modelled the effect of different screening strategies on a specific cohort of women; rather than performing multiple cohort evaluation of the effect of changing strategies for older cohorts within the screening program who have been previously screened.
The study design is a review of observational studies with critical review of multiple cohort studies.
The dynamic model of HPV transmission is implemented in Microsoft Visual C++, and the Markov model is implemented in TreeAge Pro 2008 (Release 1.3.2, TreeAge Software, Inc., MA, USA), with a Microsoft Office Excel interface integrated with Visual Basic for multiple cohort implementations.
All other cost-effectiveness studies were based on static (Markov) state-transition models or similar models using single or multiple cohorts.
Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity.
We then used these estimates as inputs to a population-level model that allocated treatment across multiple cohorts of newly detected, HIV-infected individuals when treatment capacity was limited.
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