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Pragmatic Clinical Trials Unit

Decision modelling for economic evaluation

Decision analytic modelling is a widely used method for economic analysis that enables integration of all relevant evidence and facilitates comparative analysis of multiple intervention strategies over long period of time. In this theme, we work towards development of the methods of decision analytic modelling and develop models to support rigorous evaluations in collaboration with clinicians, patients and other stakeholders. We also teach decision analytic modelling methods in our courses.

Specific topics of our work include:

  • Decision modelling for long-term economic analysis in clinical trials
  • Decision modelling for assessment of public health interventions
  • Decision modelling to support personalised medicine
  • Validation and calibration of decision models

Ongoing projects


  • CTT
  • East London CVD prevention






  • Point of care antibody testing


  • Fresh St

UK Salt reformulation policy

References to our published papers:

Alonso S, Tan M, Wang C, Kent S, Cobiac L, MacGregor G, He F, Mihaylova B (2021). Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England. Hypertension. 77( 4): 1086-1094. 10.1161/HYPERTENSIONAHA.120.16649 

Schlackow I, Simons C, Oke J, Feakins B, O'Callaghan CA, Hobbs FDR, Lasserson D, Stevens RJ, Perera R, Mihaylova B (2020). Long-term health outcomes of people with reduced kidney function in the UK: A modelling study using population health data. PLoS Med. 17(12):e1003478. 10.1371/journal.pmed.1003478

J Oke, B Feakins, I Schlackow, B Mihaylova, C Simons, C O'Callaghan, D Lasserson, R Hobbs, R Stevens, R Perera (2019). Statistical models for the deterioration of kidney function in a primary care population: A retrospective database analysis. F1000Research. 10.12688/f1000research.20229.1

Keng MJ, Tsiachristas A, Leal J, Gray A, Mihaylova B (2019). Impact of variation in Type 2 diabetes care on health and healthcare costs. Diabetes Obesity and Metabolism. 21:2405–2412. 10.1111/dom.13821

Schlackow I, Kent S, Herrington W, Emberson J, Haynes R, Reith C, Collins R, Landray MJ, Gray A, Baigent C, Mihaylova B, on behalf of the SHARP Collaborative Group (2019). Cost-effectiveness of lowering LDL cholesterol with statins and ezetimibe in chronic kidney disease. Kidney International. 96: 170–179. 10.1016/j.kint.2019.01.028

Kent S, Aveyard P, Astbury N, Mihaylova B, Jebb SA (2019). Is doctor referral to a low energy total diet replacement programme cost-effective for the routine treatment of obesity?. Obesity. 27: 391-398. 10.1002/oby.22407

Clayton G, Smith I, Higgins JPT, Mihaylova B, Thorpe B, Cicero R, Lokuge K, Forman J, Tierney JF, White IR, Sharples LD, Jones HE (2017). The INVEST project: Investigating the use of evidence synthesis in the design and analysis of clinical trials. Trials. 18:219. 10.1186/s13063-017-1955-y

Schlackow I, Kent S, Herrington W, Emberson J, Haynes R, Reith C, Wanner C, Fellström B, Gray A, Landray MJ, Baigent C, Mihaylova B on behalf of the SHARP Collaborative Group (2017). A policy model of cardiovascular disease in moderate-to-advanced chronic kidney disease. Heart.103:1880-1890. 10.1136/heartjnl-2016-310970

Kent S, Haynes R, Hopewell J, Parish S, Gray A, Landray M J, Collins R, Armitage J, Mihaylova B on behalf of the HPS2-THRIVE Collaborative Group (2016). The Effects of Vascular and Nonvascular Adverse Events and of Extended-Release Niacin with Laropiprant on Health and Healthcare Costs. Circulation: Cardiovascular Quality and Outcomes. 9:348-354. 10.1161/CIRCOUTCOMES.115.002592

Mihaylova B, Schlackow I, Herrington W, Lozano-Kühne J, Kent S, Emberson J, Reith C, Haynes R, Cass A, Craig J, Gray A, Collins R, Landray M, Baigent C (2016). Cost-effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).  American Journal of Kidney Diseases. 67(4): 576-584. 10.1053/j.ajkd.2015.09.020

Alva M L, Gray A, Mihaylova B, Leal J, Holman R R (2014). The impact of diabetes-related complications on healthcare costs: new results from the UK Prospective Diabetes Study. Diabetic Medicine. 32(4):459-466. 10.1111/dme.12647

Mihaylova B, Briggs A, O'Hagan A, Thompson SG (2011). Review of statistical methods for analysing healthcare resources and costs. Health Economics.20(8):897-916. 10.1002/hec.1653

Mihaylova B, Briggs A, Hlatky M, Armitage J, Parish S, Gray A, and Collins R (2009). Statin cost-effectiveness in the United States for people at different vascular risk levels. Circulation: Cardiovascular Quality and Outcomes. 2:65-72. 10.1161/CIRCOUTCOMES.108.808469

Briggs A, Mihaylova B, Sculpher M, Hall A, Wolstenholme J, Simoons M, Deckers J, Roberto F, Remme WJ, Bertrand M, and Fox K (2007). The Cost-effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA Study. Heart. 93: 1081-6. 10.1136/hrt.2005.086728

Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R on behalf of the Heart Protection Study Collaborative Group(2006). Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ;333:1145-8. 10.1136/bmj.38993.731725.BE

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