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hesim is a modular and computationally efficient R package for healtheconomic simulation modeling and decision analysis that provides ageneral framework for integrating statistical analyses with economicevaluation. The package supports cohort discrete time state transitionmodels (DTSTMs), N-state partitioned survival models (PSMs), andindividual-level continuous time state transition models (CTSTMs),encompassing both Markov (time-homogeneous and time-inhomogeneous) andsemi-Markov processes. It heavily utilizesRcpp anddata.table,making individual-level simulation, probabilistic sensitivity analysis(PSA), and incorporation of patient heterogeneity fast.

Features of the current version can be summarized as follows:

• Cohort DTSTMs, individual-level CTSTMs, and N-state PSMs thatencompass Markov and semi-Markov processes
• Options to build models directly from fitted statistical models or bydefining them in terms of expressions
• Parameter estimates from either anR based model or from an externalsource
• Convenience functions for sampling model parameters from parametricdistributions or via bootstrapping
• Parameter uncertainty propagated with PSA
• Modeling patient heterogeneity
• Performing cost-effectiveness analyses and representing decisionuncertainty from PSAs
• Simulation code written inC++ to boost performance

You can install thecurrentrelease from CRAN or the most up todate development version from GitHub.

# Install from CRAN:install.packages("hesim")# Install the development version from GitHub:# install.packages("devtools")devtools::install_github("hesim-dev/hesim")

There are two good places to start:

1. TheIntroduction tohesimarticle provides a quick introduction.

2. Ourpreprint describes thepackage (including mathematical details) more thoroughly.

You might also want to explore our example analyses which can be foundin the preprint and web articles. They are summarized in the tablebelow, with some drawn from theDecision Modeling for Health EconomicEvaluationtextbook. Key areas of focus are the (i) statistical models of diseaseprogression (in terms of the baseline risk and relative treatmenteffects) and (ii) the available data (either individual patient data(IPD) or aggregate-level data).

If you usehesim, please cite as follows:

To cite package 'hesim' in publications use:  Devin Incerti and Jeroen P Jansen (2021). hesim: Health Economic  Simulation Modeling and Decision Analysis. arXiv:2102.09437  [stat.AP], URL https://arxiv.org/abs/2102.09437.A BibTeX entry for LaTeX users is  @Misc{incerti2021hesim,    author = {Devin Incerti and Jeroen P. Jansen},    title = {hesim: Health Economic Simulation Modeling and Decision Analysis},    year = {2021},    eprint = {2102.09437},    archiveprefix = {arXiv},    primaryclass = {stat.AP},    url = {https://arxiv.org/abs/2102.09437},  }