Integrating Qualitative Techniques in Model Development: a case study using the framework approach Running title: Application of framework approach in model development

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Background: Despite their potential, there is limited uptake of formal qualitative methods in model development by modellers and health economists. The aim of this case study is to highlight in a real-world context how a qualitative approach has been applied to gain insight into current practice (delineating existing care pathways) for typhoid fever in Ghana which can then assist in model structure conceptualisation in a model-based cost-effectiveness analysis.
Methods: The perspectives of a range of healthcare professionals working in different settings and across different practices in the Eastern region of Ghana were captured with a self-administered survey using open-ended questions and analysed using the framework method.
Results: A total of 51 completed questionnaires were retrieved representing a 73% response rate. It was found that two main care pathways for typhoid fever exist in Ghana and there was no consensus on how a new test might be applied to the existing pathways.
Conclusion: The two settings in Ghana have different care pathways and any cost-effectiveness analysis should consider the alternative pathways separately. This study has demonstrated that framework analysis is a qualitative methodology that is likely to be accessible and feasible across a wide range of health economic settings.
Key points for Decision Makers
• Delineating care pathways during model development can be difficult and qualitative methods play a potentially key role in enhancing this process.
• Integrating qualitative methods in model development can potentially enhance the validity as well as generalizability and credibility of models.
• Framework analysis is a simple but systematic qualitative approach that can potentially enhance the process of model development.

Key words: qualitative techniques; framework method; model development; cost-effectiveness; care pathways; typhoid fever


Original languageEnglish
Pages (from-to)723–733
JournalApplied Health Economics and Health Policy
Issue number5
Early online date18 Jul 2018
Publication statusPublished - Oct 2018


  • qualitative techniques, framework method, model development, cost-effectiveness, care pathways, typhoid fever