A Framework for the Economic Evaluation of Sequential Therapies for Chronic Conditions (2014)

Cost-effectiveness models often evaluate a sequence of treatments
Downstream implications of a sequence should be captured Compare sequences within standard economic evaluation framework

For conditions such as rheumatoid arthritis, an optimal treatment sequence has not been identified[1]
Large number of sequences requires excessively large computational time (estimate cost and QALYs estimated for every sequence)
Computation time increases when using individual patient simulation
Evidence for a fully sequential model is not likely to be available