# Treatment Fees in Markov Model

Dear TP modelers:

I am building a Markov model to compare screening test strategies. If the patients receive treatment, there will be initial fees and annual fees. All the patients under treatment only pay one initial fee at the start of the treatment. However, if I put this variable into the model, does that mean each time the patient comes into the state, he will have to pay the cost once again? Thus, I wonder how I can insert an initial fee into the model.

Thank you,

Best Regards

## Comments

Andrew MunzerMarkov model values are built to support different values for the first cycle and all subsequent cycles, so you don't need another state.

Let's say you have 2 variables in your model for these costs.

Then in the health state, you would use these variables as follows...

When you run Markov Cohort Analysis for the full Markov process (at the Markov node), you will be able to check the costs in _stage 0 and all subsequent cycles.

David NaimarkThe initial fee can be placed in the initial cost box which will only be evaluated when _stage = 0. Otherwise, assuming that your cycles are monthly, the annual fees can be entered into the incremental box as if(modulo(_stage;12)=0;annualFee;0). Modulo is integer division with a remainder: modulo(11;12) = 11, modulo(12;12) = 0, modulo(13;12) = 1....modulo(23;12) = 11, modulo(24;12) = 0 etc. So modulo(_stage;12) = 0 is true every time _stage is a multiple of 12.

Of course, you'll probably want to discount annualFee

Annie@ David, thank you for your answer.

I just came up with an idea that maybe I can create a new state named TP_disease. If the patients choose to accept treatment, they will pay the initial fee and get into the TP_disease state.

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