Markov model, 3 month cycles, 10 years

Health economics poster

A health economics poster stands or falls on whether its table adds up and its uncertainty is on the board rather than in the appendix. This A0 portrait example carries a cost and QALY table whose totals are the sums of their rows, an ICER of 4,120 per QALY as the key number, and a tornado chart showing which input moves it.

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The whole board

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MU
Home based cardiac rehabilitation costs 4,120 per QALY gained against centre based care over ten years
E. Lindgren ¹, F. Achebe ¹, R. Kowalczyk ²
1 Centre for Health Economics, Marlowe University · 2 Northgate Heart Institute
Abstract
A four state Markov model followed a cohort of 1,000 post infarction patients aged 62 through ten years of home based against centre based cardiac rehabilitation, from the healthcare payer perspective. Home based care cost 7,438 per patient against 7,150, gained 6.92 QALYs against 6.85, for an ICER of 4,120 per QALY gained. At a willingness to pay of 30,000 per QALY, home based rehabilitation was cost effective in 91 percent of 5,000 probabilistic runs and dominant in 12 percent. All costs are in local currency units.
METHODS
Model. Four state Markov: well, readmitted, post readmission, dead. Three month cycles over a ten year horizon.
Population. Cohort of 1,000 post infarction patients, mean age 62, 68 percent male, entering at discharge.
Inputs. Programme costs from two trials, readmission rates from a national registry, utilities from a published catalogue.
Discounting. 3.5 percent per year on both costs and outcomes, from the healthcare payer perspective in local currency units.
Uncertainty. 5,000 probabilistic runs, plus one way sensitivity analysis on the eight largest inputs; the six that move the ICER most are charted.
Why home based rehabilitation
Cardiac rehabilitation is among the best evidenced services in cardiology and among the worst attended. In the registry feeding this model, only 38 percent of eligible patients took up a centre based programme, against 61 percent offered a home based one with weekly phone support. A cheaper programme that reaches nobody helps nobody, so uptake is the reason the comparison matters. The model asks what the payer gives up in cost and gains in health when the default offer moves from the centre to the home.
Discussion
Two limits sit under these numbers, and both push in stated directions. The payer perspective excludes patient costs, and travel is the largest cost a centre based programme imposes on patients, so a societal analysis would favour home care further than this one does. The utility catalogue was estimated in a different population from the registry that supplied readmission rates; if post readmission utility is lower here, the QALY gain grows. The model also treats uptake as a parameter rather than a behaviour, yet the tornado shows even the pessimistic uptake value leaves the ICER under 4,300. What would change the conclusion is a readmission rate at the low end of its range, and that is exactly the input the next data refresh will pin down.
COSTS AND OUTCOMES, 10 YEARS
Item
Centre based
Home based
Difference
Programme cost
1,240
890
-350
Readmission cost
4,310
4,120
-190
Other care
1,600
2,428
+828
Total cost
7,150
7,438
+288
Life years
7.61
7.68
+0.07
QALYs
6.85
6.92
+0.07
ICER per QALY
 
 
4,120
Cost effective at 30,000
 
 
91 percent
Per patient, discounted, local currency units. The model runs on unrounded inputs, so the printed 288 and 0.07 give 4,120, not 4,114.
High input
Low input
025005000750010000
Well utility
Discount
Uptake
Figure 1. One way sensitivity, ICER low and high per input. Top to bottom: readmission, well utility, home cost, discount, other care, uptake.
Source: Trial dataset, 2026.
Results
The base case ICER was 4,120 per QALY gained. Of 5,000 probabilistic runs, 91 percent fell under a 30,000 threshold and 12 percent showed home care dominant, cheaper and more effective at once. Readmission rate was the only input pushing the ICER past 8,000; none pushed it past the threshold. Every total in the table is the sum of the three cost rows above it.
4,120
per QALY gained, home against centre based care
One way sensitivity range 1,900 to 8,400; 91% of runs cost effective at 30,000
CONCLUSION
At 4,120 per QALY, home based cardiac rehabilitation is comfortably cost effective for this payer. The result survives every sensitivity tested, and the one input that could still move it is named on the board.
ICER 4,120 per QALY gained over ten years
Cost effective in 91 percent of 5,000 runs
Readmission rate drives the result
Add patient costs in the next version
REFERENCES
1.Lindgren E, Achebe F. Home based cardiac rehabilitation with telephone support: a pragmatic trial. Cardiac Care Studies 2024;15(2):88-104.
2.Kowalczyk R, Lindgren E. Utilities for post infarction health states: a catalogue for modellers. Health Valuation Notes 2023;6(4):210-226.
3.Achebe F, Marsh T. Readmission after myocardial infarction in a national registry, 2015 to 2024. Registry Reports 2025;11(1):12-29.

Block by block

What each block on the board is for, in the order a reader walks it.

Title band and authors
The title prints the answer with its unit: home based cardiac rehabilitation costs 4,120 per QALY gained against centre based care over ten years. The heart institute that supplied the clinical question shares the author block with the health economics centre that built the model.
Abstract
One paragraph carries the cohort of 1,000 patients, both totals, both QALY figures, the ICER and the probabilistic result, cost effective in 91 percent of 5,000 runs at a 30,000 threshold and dominant in 12 percent. Every number in it reappears in the table or the results block below.
Methods: the model as five entries
The protocol names the four state Markov structure, the three month cycle and ten year horizon, the cohort, the input sources, 3.5 percent discounting from the payer perspective, and the uncertainty work: 5,000 probabilistic runs plus one way sensitivity on the eight largest inputs.
Introduction: why home based programmes
The intro block carries the uptake numbers that motivate the model: only 38 percent of eligible patients took up a centre based programme in the registry, against 61 percent offered a home based one. A cheaper programme that reaches nobody helps nobody, which is why the comparison is worth a board.
Costs and outcomes per patient (table)
The eight row table is the centre of the board: three cost rows summing to each total, 7,150 centre and 7,438 home, then life years, QALYs, the ICER and the probability row. The caption states that the model runs on unrounded inputs, which is why 288 over 0.07 prints as 4,120 rather than 4,114.
One way sensitivity (Figure 1)
The tornado is drawn as paired horizontal bars, low and high value per input, for the six inputs that move the ICER most. Readmission rate spans 1,900 to 8,400 and dwarfs the rest; discount rate, other care cost and uptake barely move it. One chart answers the what if question.
Results and the ICER
The results block states the base case at 4,120, the 91 percent of runs under threshold, the 12 percent where home care dominates, and the single sentence a decision maker needs: no tested input pushes the ICER past the 30,000 threshold. The stat block repeats 4,120 with the sensitivity range underneath.
Discussion, conclusion points and references
The discussion pushes both stated limits in their known directions: excluding patient travel favours centre care, so a societal analysis would strengthen the result, and the utility catalogue comes from another population. The three references are invented for this fictional study, because the reference block is required on this layout; replace them with your sources.
How to adapt this board
Put your two arms in the table columns and keep the cost rows to three so the totals stay auditable. Chart your own tornado with the six inputs that matter, state the perspective and discount rate in methods, and put the ICER in the stat block with its sensitivity range, not just the point estimate.

What makes this board work

The table adds up

Each total is the sum of the three cost rows above it, 1,240 plus 4,310 plus 1,600 gives 7,150, and the ICER row is the cost difference over the QALY difference. A reviewer with a calculator finds no surprises.

The interval is on the board

The stat detail carries the one way sensitivity range of 1,900 to 8,400 under the 4,120 headline, so the uncertainty travels with the number instead of living in a supplementary file.

One chart, the one that matters

The tornado shows readmission rate driving the result while five other inputs move the ICER by less than 1,700 each, which tells the audience exactly which parameter to argue about.

Questions people ask

What goes on a health economics poster?

The model structure, the input sources, a cost and outcome table, the ICER with its uncertainty, a tornado or equivalent sensitivity chart, and the perspective. This board carries all six and keeps the model diagram out: the four states fit in one protocol entry as text.

How do I draw a tornado chart?

Use a horizontal bar chart with two series, one for each input at its low value and one at its high value, ordered so the widest pair sits on top. The chart slot on this layout accepts horizontal bars among its ten kinds, and this board charts six inputs, which is as many as stay readable.

Can the table hold a CEAC as well?

No, this layout has one figure slot and the tornado earns it. The cost effectiveness acceptability result is a sentence, cost effective in 91 percent of runs at 30,000, and this board prints that in the abstract, the table and the results block rather than spending the only chart on it.

Should I show the model diagram?

No poster layout carries a fillable diagram or image slot, and a four state model does not need one: well, readmitted, post readmission and dead, named in the first methods entry, is a complete description. A model with a dozen states belongs in the paper behind the QR code, not on a board.

Which perspective goes on the board?

The one the analysis actually took, stated in methods where the discount rate is. This board says healthcare payer, and the discussion then names what that excludes, patient travel, and the direction the exclusion pushes. Perspective stated plus direction of bias is the honest pattern.

Where does the CHEERS checklist go?

Behind the QR code with the full model. CHEERS is a reporting standard for the paper, not a poster block, but the board should survive a CHEERS minded reader: perspective, horizon, discounting, uncertainty and funding all appear on this example in their expected places.

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Sources

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