Introduction to metamodeling for reducing computational burden of advanced analyses with health economic models : a structured overview of metamodeling methods in a 6-step application process

Metamodels can be used to reduce the computational burden associated with computationally demanding analyses of simulation models, though applications within health economics are still scarce. Besides a lack of awareness of their potential within health economics, the absence of guidance on the conceivably complex and time-consuming process of developing and validating metamodels may contribute to their limited uptake. To address these issues, this paper introduces metamodeling to the wider health economic audience and presents a process for applying metamodeling in this context, including suitable methods and directions for their selection and use. General (i.e., non-health economic specific) metamodeling literature, clinical prediction modeling literature, and a previously published literature review were exploited to consolidate a process and to identify candidate metamodeling methods. Methods were considered applicable to health economics if they are able to account for mixed (i.e., continuous and discrete) input parameters and continuous outcomes. Six steps were identified as relevant for applying metamodeling methods within health economics, i.e. 1) the identification of a suitable metamodeling technique, 2) simulation of datasets according to a design of experiments, 3) fitting of the metamodel, 4) assessment of metamodel performance, 5) conduct the required analysis using the metamodel, and 6) verification of the results. Different methods are discussed to support each step, including their characteristics, directions for use, key references, and relevant R and Python packages. To address challenges regarding metamodeling methods selection, a first guide was developed towards using metamodels to reduce the computational burden of analyses of health economic models. This guidance may increase applications of metamodeling in health economics, enabling increased use of state-of-the-art analyses, e.g. value of information analysis, with computationally burdensome simulation models.