changing costs and utilities in a markov cancer health state

In a CUA model for cancer screening, how do you model a state that has changing costs and utilities depending on the cycle. 

Specifically, once the patient enters a post-cancer state, utilities and costs progressively increase for 5 years, and then remain stable from the 6th year on.

If I simply use  _stage, I understand the formula would change according to how many cycles have passed, not specifically according to how many cycles the patient spent in each state. 

Is is possible to use tunnels to solve this? Or the tunnel function works only for increasing probabilities?

How do you handle this?

Thank you!

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  • You have the right idea. Tunnel states is what you want.

    If you setup the post-cancer state as a tunnel state, you can track how long any part of the cohort has been in that state using the keyword _tunnel. Since your cost change for the first 5 years then remain stable from year 6 on, you will set the tunnel max to 5 in the Markov Info View for the post-cancer state (note it might be 6 if I interpreted your question wrong).

    Then you can use a formula for the cost that references the keyword _tunnel. Using this for cost is the same as it would be for probabilities.

    Andrew

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