heor-agent-mcp 0.2.0 → 0.7.0

package/dist/tools/budgetImpactModel.js

@@ -0,0 +1,257 @@
+import { z } from "zod";
+import { createAuditRecord, addAssumption, setMethodology, } from "../audit/builder.js";
+import { auditToMarkdown } from "../formatters/markdown.js";
+import { contentToDocx } from "../formatters/docx.js";
+import { saveReport } from "../knowledge/index.js";
+const BudgetImpactSchema = z.object({
+    intervention: z.string().min(1),
+    comparator: z.string().min(1),
+    indication: z.string().min(1),
+    perspective: z.enum(["nhs", "us_payer", "societal"]),
+    time_horizon_years: z.number().int().min(1).max(10).default(5),
+    eligible_population: z.number().positive(),
+    population_growth_rate: z.number().min(-0.1).max(0.2).default(0.0),
+    market_share: z.object({
+        year_1: z.number().min(0).max(1),
+        year_2: z.number().min(0).max(1).optional(),
+        year_3: z.number().min(0).max(1).optional(),
+        year_4: z.number().min(0).max(1).optional(),
+        year_5: z.number().min(0).max(1).optional(),
+    }),
+    drug_cost_annual: z.number().nonnegative(),
+    comparator_cost_annual: z.number().nonnegative(),
+    admin_cost_annual: z.number().nonnegative().default(0),
+    monitoring_cost_annual: z.number().nonnegative().default(0),
+    ae_cost_annual: z.number().nonnegative().default(0),
+    comparator_ae_cost_annual: z.number().nonnegative().default(0),
+    displacement: z
+        .array(z.object({
+        treatment: z.string(),
+        share: z.number().min(0).max(1),
+        cost_annual: z.number().nonnegative(),
+    }))
+        .optional(),
+    output_format: z.enum(["text", "json", "docx"]).optional(),
+    project: z.string().optional(),
+});
+const CURRENCY = {
+    nhs: { symbol: "\u00A3", name: "GBP" },
+    us_payer: { symbol: "$", name: "USD" },
+    societal: { symbol: "$", name: "USD" },
+};
+function computeBudgetImpact(params) {
+    const years = params.time_horizon_years;
+    const shares = [
+        params.market_share.year_1,
+        params.market_share.year_2,
+        params.market_share.year_3,
+        params.market_share.year_4,
+        params.market_share.year_5,
+    ];
+    // Interpolate/extrapolate market share for missing years
+    let lastDefinedIdx = 0;
+    for (let i = 0; i < shares.length; i++) {
+        if (shares[i] !== undefined)
+            lastDefinedIdx = i;
+    }
+    for (let i = 1; i < years; i++) {
+        if (shares[i] === undefined) {
+            shares[i] = shares[lastDefinedIdx];
+        }
+    }
+    const interventionAnnualCost = params.drug_cost_annual +
+        params.admin_cost_annual +
+        params.monitoring_cost_annual +
+        params.ae_cost_annual;
+    const comparatorAnnualCost = params.comparator_cost_annual +
+        params.admin_cost_annual +
+        params.comparator_ae_cost_annual;
+    // Displaced treatments: cost saved by switching patients from existing therapies
+    const displacementCostPerPatient = (params.displacement ?? []).reduce((sum, d) => sum + d.share * d.cost_annual, 0);
+    const results = [];
+    for (let y = 0; y < years; y++) {
+        const pop = Math.round(params.eligible_population *
+            Math.pow(1 + params.population_growth_rate, y));
+        const share = shares[y] ?? shares[lastDefinedIdx] ?? 0;
+        const treated = Math.round(pop * share);
+        const untreated = pop - treated;
+        const intCost = treated * interventionAnnualCost;
+        const compCost = untreated * comparatorAnnualCost;
+        const displacedSaved = treated * displacementCostPerPatient;
+        // Net = new world cost - old world cost
+        // Old world: everyone on comparator
+        const oldWorldCost = pop * comparatorAnnualCost;
+        const newWorldCost = intCost + compCost;
+        const net = newWorldCost - oldWorldCost - displacedSaved;
+        results.push({
+            year: y + 1,
+            eligible_population: pop,
+            treated_population: treated,
+            intervention_cost: intCost,
+            comparator_cost: compCost,
+            displaced_cost_saved: displacedSaved,
+            net_budget_impact: net,
+            per_patient_cost: treated > 0 ? net / treated : 0,
+        });
+    }
+    return results;
+}
+export async function handleBudgetImpactModel(rawParams) {
+    const params = BudgetImpactSchema.parse(rawParams);
+    const outputFormat = params.output_format ?? "text";
+    const { symbol } = CURRENCY[params.perspective];
+    let audit = createAuditRecord("budget_impact_model", params, outputFormat);
+    audit = setMethodology(audit, "ISPOR Budget Impact Analysis good practice (Mauskopf 2007, Sullivan 2014)");
+    audit = addAssumption(audit, `Perspective: ${params.perspective}`);
+    audit = addAssumption(audit, `Time horizon: ${params.time_horizon_years} years`);
+    audit = addAssumption(audit, `Eligible population: ${params.eligible_population.toLocaleString()} (growth: ${(params.population_growth_rate * 100).toFixed(1)}%/yr)`);
+    const results = computeBudgetImpact(params);
+    const totalNetImpact = results.reduce((s, r) => s + r.net_budget_impact, 0);
+    const totalTreated = results.reduce((s, r) => s + r.treated_population, 0);
+    if (outputFormat === "json") {
+        return {
+            content: {
+                years: results,
+                total_net_budget_impact: totalNetImpact,
+                total_patients_treated: totalTreated,
+                currency: CURRENCY[params.perspective].name,
+            },
+            audit,
+        };
+    }
+    const fmt = (n) => `${symbol}${Math.round(n).toLocaleString()}`;
+    const lines = [
+        `## Budget Impact Analysis: ${params.intervention} vs ${params.comparator}`,
+        `**Indication:** ${params.indication} | **Perspective:** ${params.perspective.toUpperCase()} | **Horizon:** ${params.time_horizon_years} years`,
+        ``,
+        `### Year-by-Year Budget Impact`,
+        `| Year | Eligible Pop. | Treated | Market Share | Net Budget Impact | Per Patient |`,
+        `|------|--------------|---------|-------------|-------------------|-------------|`,
+        ...results.map((r) => `| ${r.year} | ${r.eligible_population.toLocaleString()} | ${r.treated_population.toLocaleString()} | ${((r.treated_population / r.eligible_population) * 100).toFixed(1)}% | ${fmt(r.net_budget_impact)} | ${fmt(r.per_patient_cost)} |`),
+        `| **Total** | | **${totalTreated.toLocaleString()}** | | **${fmt(totalNetImpact)}** | |`,
+        ``,
+        `### Summary`,
+        `- **Total net budget impact** over ${params.time_horizon_years} years: **${fmt(totalNetImpact)}**`,
+        `- **Average per-patient annual cost difference:** ${fmt(totalNetImpact / (totalTreated || 1))}`,
+        totalNetImpact > 0
+            ? `- The intervention **increases** total budget by ${fmt(totalNetImpact)} over ${params.time_horizon_years} years`
+            : `- The intervention **saves** ${fmt(Math.abs(totalNetImpact))} over ${params.time_horizon_years} years`,
+        ``,
+        params.displacement && params.displacement.length > 0
+            ? `### Treatment Displacement\n${params.displacement.map((d) => `- ${d.treatment}: ${(d.share * 100).toFixed(0)}% displaced (${fmt(d.cost_annual)}/yr)`).join("\n")}\n`
+            : "",
+        `---`,
+        `> **Disclaimer:** This is a preliminary budget impact estimate for orientation purposes only. Results require validation by a qualified health economist before use in any HTA submission or payer negotiation.`,
+        ``,
+        auditToMarkdown(audit),
+    ]
+        .filter(Boolean)
+        .join("\n");
+    if (outputFormat === "docx") {
+        const base64 = await contentToDocx("Budget Impact Analysis Report", lines, audit);
+        const filenameStem = `bia-${params.intervention.slice(0, 30)}-vs-${params.comparator.slice(0, 30)}`;
+        const savedPath = await saveReport(base64, filenameStem, params.project);
+        const sizeKb = Math.round(base64.length / 1024);
+        return {
+            content: `## DOCX Report Generated\n\n**File:** \`${savedPath}\`\n**Size:** ${sizeKb} KB\n\nOpen with: \`open "${savedPath}"\``,
+            audit,
+        };
+    }
+    return { content: lines, audit };
+}
+export const budgetImpactModelToolSchema = {
+    name: "budget_impact_model",
+    description: "Estimate the total budget impact of adopting a new intervention over 1-5 years. Follows ISPOR Budget Impact Analysis good practice guidelines (Mauskopf 2007, Sullivan 2014). Computes year-by-year net cost to payer, including market share uptake, treatment displacement, and population growth.",
+    inputSchema: {
+        type: "object",
+        properties: {
+            intervention: { type: "string", description: "New drug or treatment" },
+            comparator: {
+                type: "string",
+                description: "Current standard of care",
+            },
+            indication: { type: "string", description: "Disease or condition" },
+            perspective: { type: "string", enum: ["nhs", "us_payer", "societal"] },
+            time_horizon_years: {
+                type: "number",
+                description: "Budget horizon in years (1-10, default 5)",
+            },
+            eligible_population: {
+                type: "number",
+                description: "Number of eligible patients in Year 1",
+            },
+            population_growth_rate: {
+                type: "number",
+                description: "Annual population growth rate (e.g., 0.02 for 2%). Default 0.",
+            },
+            market_share: {
+                type: "object",
+                description: "Expected market share of intervention by year (0-1). Missing years extrapolate from last defined.",
+                properties: {
+                    year_1: { type: "number" },
+                    year_2: { type: "number" },
+                    year_3: { type: "number" },
+                    year_4: { type: "number" },
+                    year_5: { type: "number" },
+                },
+                required: ["year_1"],
+            },
+            drug_cost_annual: {
+                type: "number",
+                description: "Annual drug acquisition cost for intervention",
+            },
+            comparator_cost_annual: {
+                type: "number",
+                description: "Annual drug cost for comparator",
+            },
+            admin_cost_annual: {
+                type: "number",
+                description: "Annual administration cost (applies to both arms). Default 0.",
+            },
+            monitoring_cost_annual: {
+                type: "number",
+                description: "Annual monitoring cost for intervention. Default 0.",
+            },
+            ae_cost_annual: {
+                type: "number",
+                description: "Annual adverse event cost for intervention. Default 0.",
+            },
+            comparator_ae_cost_annual: {
+                type: "number",
+                description: "Annual adverse event cost for comparator. Default 0.",
+            },
+            displacement: {
+                type: "array",
+                description: "Existing treatments displaced by intervention (share of patients switching, cost saved)",
+                items: {
+                    type: "object",
+                    properties: {
+                        treatment: { type: "string" },
+                        share: {
+                            type: "number",
+                            description: "Fraction of treated patients displaced (0-1)",
+                        },
+                        cost_annual: {
+                            type: "number",
+                            description: "Annual cost of displaced treatment",
+                        },
+                    },
+                    required: ["treatment", "share", "cost_annual"],
+                },
+            },
+            output_format: { type: "string", enum: ["text", "json", "docx"] },
+            project: { type: "string", description: "Project ID for persistence" },
+        },
+        required: [
+            "intervention",
+            "comparator",
+            "indication",
+            "perspective",
+            "eligible_population",
+            "market_share",
+            "drug_cost_annual",
+            "comparator_cost_annual",
+        ],
+    },
+};
+//# sourceMappingURL=budgetImpactModel.js.map

package/dist/tools/budgetImpactModel.js.map

@@ -0,0 +1 @@
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package/dist/tools/costEffectivenessModel.d.ts

@@ -83,6 +83,24 @@ export declare const costEffectivenessModelToolSchema: {
                 type: string;
                 description: string;
             };
+            scenarios: {
+                type: string;
+                description: string;
+                items: {
+                    type: string;
+                    properties: {
+                        name: {
+                            type: string;
+                            description: string;
+                        };
+                        overrides: {
+                            type: string;
+                            description: string;
+                        };
+                    };
+                    required: string[];
+                };
+            };
             output_format: {
                 type: string;
                 enum: string[];

package/dist/tools/costEffectivenessModel.d.ts.map

@@ -1 +1 @@
-{"version":3,"file":"costEffectivenessModel.d.ts","sourceRoot":"","sources":["../../src/tools/costEffectivenessModel.ts"],"names":[],"mappings":"AACA,OAAO,KAAK,EAEV,UAAU,EAKX,MAAM,uBAAuB,CAAC;AA6F/B,wBAAsB,4BAA4B,CAChD,SAAS,EAAE,OAAO,GACjB,OAAO,CAAC,UAAU,CAAC,CAuTrB;AAED,eAAO,MAAM,gCAAgC;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;CA2E5C,CAAC"}
+{"version":3,"file":"costEffectivenessModel.d.ts","sourceRoot":"","sources":["../../src/tools/costEffectivenessModel.ts"],"names":[],"mappings":"AACA,OAAO,KAAK,EAEV,UAAU,EAKX,MAAM,uBAAuB,CAAC;AAoN/B,wBAAsB,4BAA4B,CAChD,SAAS,EAAE,OAAO,GACjB,OAAO,CAAC,UAAU,CAAC,CAuVrB;AAED,eAAO,MAAM,gCAAgC;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;CA+F5C,CAAC"}

package/dist/tools/costEffectivenessModel.js

@@ -29,13 +29,43 @@ const CEModelSchema = z.object({
     run_psa: z.boolean().optional(),
     psa_iterations: z.number().int().min(1).max(10000).optional(),
     run_owsa: z.boolean().optional(),
+    scenarios: z
+        .array(z.object({
+        name: z.string().min(1),
+        overrides: z.object({
+            time_horizon: z
+                .union([z.enum(["lifetime", "5yr", "10yr"]), z.number().positive()])
+                .optional(),
+            perspective: z.enum(["nhs", "us_payer", "societal"]).optional(),
+            clinical_inputs: z
+                .object({
+                efficacy_delta: z.number().min(0).max(1).optional(),
+                mortality_reduction: z.number().min(0).max(1).optional(),
+            })
+                .optional(),
+            cost_inputs: z
+                .object({
+                drug_cost_annual: z.number().nonnegative().optional(),
+                comparator_cost_annual: z.number().nonnegative().optional(),
+            })
+                .optional(),
+            utility_inputs: z
+                .object({
+                qaly_on_treatment: z.number().min(0).max(1).optional(),
+                qaly_comparator: z.number().min(0).max(1).optional(),
+            })
+                .optional(),
+        }),
+    }))
+        .max(10)
+        .optional(),
     output_format: z.enum(["text", "json", "docx"]).optional(),
     project: z.string().optional(),
 });
 import { runPartSA } from "../models/partsa.js";
 import { runPSA } from "../models/psa.js";
 import { runOWSA, buildDefaultOWSAParameters } from "../models/owsa.js";
-import { runMarkovAndComputeICER, } from "../models/modelUtils.js";
+import { runMarkovAndComputeICER, getTimeHorizonYears, } from "../models/modelUtils.js";
 import { createAuditRecord, addAssumption, setMethodology, } from "../audit/builder.js";
 import { auditToMarkdown } from "../formatters/markdown.js";
 import { contentToDocx } from "../formatters/docx.js";
@@ -47,17 +77,69 @@ const WTP_THRESHOLDS = {
     societal: { low: 50000, high: 100000, currency: "USD", symbol: "$" },
 };
 const DISCOUNT_RATE = 0.035;
-function getTimeHorizonYears(horizon) {
-    if (horizon === "lifetime")
-        return 40;
-    if (horizon === "5yr")
-        return 5;
-    if (horizon === "10yr")
-        return 10;
-    return Number(horizon);
+/**
+ * Run scenario analysis: re-run the CE model with parameter overrides.
+ * Returns markdown table comparing base case to each scenario.
+ */
+function buildScenarioSection(params, symbol) {
+    if (!params.scenarios || params.scenarios.length === 0)
+        return [];
+    const lines = [
+        `### Scenario Analysis`,
+        `| Scenario | ICER | Delta Cost | Delta QALY | Verdict |`,
+        `|----------|------|-----------|------------|---------|`,
+    ];
+    // Base case row
+    const baseResult = runMarkovAndComputeICER(params);
+    const baseIcer = isFinite(baseResult.icer)
+        ? `${symbol}${Math.round(baseResult.icer).toLocaleString()}`
+        : baseResult.delta_cost <= 0 && baseResult.delta_qaly >= 0
+            ? "Dominant"
+            : "Dominated";
+    lines.push(`| **Base case** | ${baseIcer} | ${symbol}${Math.round(baseResult.delta_cost).toLocaleString()} | ${baseResult.delta_qaly.toFixed(3)} | — |`);
+    for (const scenario of params.scenarios) {
+        // Deep merge overrides into base params
+        const merged = {
+            ...params,
+            ...scenario.overrides,
+            clinical_inputs: {
+                ...params.clinical_inputs,
+                ...(scenario.overrides.clinical_inputs ??
+                    {}),
+            },
+            cost_inputs: {
+                ...params.cost_inputs,
+                ...(scenario.overrides.cost_inputs ?? {}),
+            },
+            utility_inputs: params.utility_inputs
+                ? {
+                    ...params.utility_inputs,
+                    ...(scenario.overrides.utility_inputs ?? {}),
+                }
+                : undefined,
+        };
+        // Remove scenarios from merged to avoid recursion
+        delete merged.scenarios;
+        const result = runMarkovAndComputeICER(merged);
+        const perspective = scenario.overrides.perspective ?? params.perspective;
+        const threshold = WTP_THRESHOLDS[perspective];
+        const verdict = wtpVerdict(result.icer, threshold, result.delta_cost, result.delta_qaly);
+        const icerStr = isFinite(result.icer)
+            ? `${symbol}${Math.round(result.icer).toLocaleString()}`
+            : result.delta_cost <= 0 && result.delta_qaly >= 0
+                ? "Dominant"
+                : "Dominated";
+        lines.push(`| ${scenario.name} | ${icerStr} | ${symbol}${Math.round(result.delta_cost).toLocaleString()} | ${result.delta_qaly.toFixed(3)} | ${verdict} |`);
+    }
+    lines.push(``);
+    return lines;
 }
-function wtpVerdict(icer, threshold) {
-    if (!isFinite(icer) && icer < 0)
+function wtpVerdict(icer, threshold, delta_cost, delta_qaly) {
+    // Dominant: lower cost AND higher QALYs — always cost-effective
+    if (delta_cost <= 0 && delta_qaly >= 0 && (delta_cost < 0 || delta_qaly > 0))
+        return "cost_effective";
+    // Dominated: higher cost AND lower QALYs — never cost-effective
+    if (delta_cost >= 0 && delta_qaly <= 0 && (delta_cost > 0 || delta_qaly < 0))
         return "dominated";
     if (!isFinite(icer))
         return "not_cost_effective";
@@ -67,14 +149,14 @@ function wtpVerdict(icer, threshold) {
         return "borderline";
     return "not_cost_effective";
 }
-function buildWTPAssessment(icer, perspective) {
+function buildWTPAssessment(icer, perspective, delta_cost, delta_qaly) {
     const threshold = WTP_THRESHOLDS[perspective];
     return {
         threshold_low: threshold.low,
         threshold_high: threshold.high,
         currency: threshold.currency,
         symbol: threshold.symbol,
-        verdict: wtpVerdict(icer, threshold),
+        verdict: wtpVerdict(icer, threshold, delta_cost, delta_qaly),
     };
 }
 export async function handleCostEffectivenessModel(rawParams) {
@@ -161,7 +243,7 @@ export async function handleCostEffectivenessModel(rawParams) {
         comparator_qaly = markovResult.comparator_qaly;
         intervention_lys = markovResult.intervention_lys;
         comparator_lys = markovResult.comparator_lys;
-        stateNames = params.states ?? ["On-Treatment", "Off-Treatment"];
+        stateNames = params.states ?? ["On-Treatment", "Off-Treatment", "Dead"];
         nCycles = years;
     }
     const incremental_lys = intervention_lys - comparator_lys;
@@ -173,6 +255,7 @@ export async function handleCostEffectivenessModel(rawParams) {
             base_params: params,
             n_iterations,
             seed: 12345,
+            evpi_lambda: threshold.low,
         });
         psaSummary = {
             iterations: n_iterations,
@@ -182,6 +265,11 @@ export async function handleCostEffectivenessModel(rawParams) {
             prob_cost_effective: psaResult.prob_cost_effective,
             ceac: psaResult.ceac,
             evpi: psaResult.evpi,
+            evppi: psaResult.evppi.map((e) => ({
+                parameter: e.parameter,
+                evppi: e.evppi,
+                evppi_proportion: e.evppi_proportion,
+            })),
             scatter: psaResult.scatter_sample.map((it) => ({
                 delta_cost: it.delta_cost,
                 delta_qaly: it.delta_qaly,
@@ -204,9 +292,9 @@ export async function handleCostEffectivenessModel(rawParams) {
     }
     // --- WTP Analysis ---
     const wtp_analysis = {
-        nhs: buildWTPAssessment(icer, "nhs"),
-        us_payer: buildWTPAssessment(icer, "us_payer"),
-        societal: buildWTPAssessment(icer, "societal"),
+        nhs: buildWTPAssessment(icer, "nhs", delta_cost, delta_qaly),
+        us_payer: buildWTPAssessment(icer, "us_payer", delta_cost, delta_qaly),
+        societal: buildWTPAssessment(icer, "societal", delta_cost, delta_qaly),
     };
     // --- Build result ---
     const modelResult = {
@@ -238,17 +326,27 @@ export async function handleCostEffectivenessModel(rawParams) {
         return { content: modelResult, audit };
     }
     // --- Text output (backwards-compatible) ---
-    const icerFormatted = isFinite(icer)
-        ? Math.round(icer).toLocaleString()
-        : "Dominated";
+    const isDominant = delta_cost <= 0 && delta_qaly >= 0 && (delta_cost < 0 || delta_qaly > 0);
+    const isDominated = delta_cost >= 0 && delta_qaly <= 0 && (delta_cost > 0 || delta_qaly < 0);
+    const icerFormatted = isDominant
+        ? "Dominant"
+        : isDominated
+            ? "Dominated"
+            : isFinite(icer)
+                ? Math.round(icer).toLocaleString()
+                : "N/A";
     const perspectiveVerdict = wtp_analysis[params.perspective];
-    const interpretation = isFinite(icer) && icer >= 0
-        ? icer < threshold.low
-            ? `${symbol}${icerFormatted}/QALY — likely cost-effective (below NICE threshold of ${symbol}${threshold.low.toLocaleString()})`
-            : icer < threshold.high
-                ? `${symbol}${icerFormatted}/QALY — borderline cost-effective (within ${symbol}${threshold.low.toLocaleString()}–${symbol}${threshold.high.toLocaleString()} threshold range)`
-                : `${symbol}${icerFormatted}/QALY — not cost-effective at standard threshold`
-        : "Dominated — intervention costs more and provides less benefit than comparator";
+    const interpretation = isDominant
+        ? "Dominant — intervention is less costly and more effective than comparator"
+        : isDominated
+            ? "Dominated — intervention costs more and provides less benefit than comparator"
+            : isFinite(icer) && icer >= 0
+                ? icer < threshold.low
+                    ? `${symbol}${icerFormatted}/QALY — likely cost-effective (below NICE threshold of ${symbol}${threshold.low.toLocaleString()})`
+                    : icer < threshold.high
+                        ? `${symbol}${icerFormatted}/QALY — borderline cost-effective (within ${symbol}${threshold.low.toLocaleString()}–${symbol}${threshold.high.toLocaleString()} threshold range)`
+                        : `${symbol}${icerFormatted}/QALY — not cost-effective at standard threshold`
+                : "ICER could not be computed";
     // PSA section
     const psaSection = [];
     if (psaSummary) {
@@ -257,6 +355,17 @@ export async function handleCostEffectivenessModel(rawParams) {
             : (psaSummary.prob_cost_effective["us_payer_low"] ?? 0);
         const pcePercent = Math.round(pcePerspective * 100);
         psaSection.push(`### Probabilistic Sensitivity Analysis (PSA)`, `Based on ${psaSummary.iterations.toLocaleString()} Monte Carlo iterations:`, `- **Mean ICER:** ${symbol}${Math.round(psaSummary.mean_icer).toLocaleString()}/QALY`, `- **95% CI:** ${symbol}${Math.round(psaSummary.ci_icer_lower).toLocaleString()} – ${symbol}${Math.round(psaSummary.ci_icer_upper).toLocaleString()}/QALY`, `- **Probability cost-effective** at ${params.perspective} threshold: **${pcePercent}%**`, `- **EVPI:** ${symbol}${Math.round(psaSummary.evpi).toLocaleString()} (expected value of perfect information)`, ``);
+        // EVPPI section
+        if (psaSummary.evppi && psaSummary.evppi.length > 0) {
+            psaSection.push(`#### EVPPI (Partial Value of Information)`);
+            psaSection.push(`Which parameters are worth further research:`);
+            psaSection.push(`| Parameter | EVPPI | % of EVPI |`);
+            psaSection.push(`|-----------|-------|-----------|`);
+            for (const ev of psaSummary.evppi.slice(0, 5)) {
+                psaSection.push(`| ${ev.parameter} | ${symbol}${Math.round(ev.evppi).toLocaleString()} | ${(ev.evppi_proportion * 100).toFixed(1)}% |`);
+            }
+            psaSection.push(``);
+        }
     }
     // OWSA section (top 5)
     const owsaSection = [];
@@ -297,6 +406,7 @@ export async function handleCostEffectivenessModel(rawParams) {
         ``,
         ...psaSection,
         ...owsaSection,
+        ...buildScenarioSection(params, symbol),
         `### Model Structure`,
         `Multi-state Markov model with half-cycle correction. Discounted at ${DISCOUNT_RATE * 100}% per NICE reference case.`,
         `States: ${stateNames.join(", ")} | Cycles: ${nCycles} annual cycles`,
@@ -388,6 +498,24 @@ export const costEffectivenessModelToolSchema = {
                 type: "number",
                 description: "PSA iterations (default: 1000, max: 10000)",
             },
+            scenarios: {
+                type: "array",
+                description: "Optional scenario analysis: array of named parameter overrides. Each scenario re-runs the model with the specified changes. Max 10 scenarios.",
+                items: {
+                    type: "object",
+                    properties: {
+                        name: {
+                            type: "string",
+                            description: "Scenario name (e.g., '20% price reduction')",
+                        },
+                        overrides: {
+                            type: "object",
+                            description: "Parameter overrides (time_horizon, perspective, clinical_inputs, cost_inputs, utility_inputs)",
+                        },
+                    },
+                    required: ["name", "overrides"],
+                },
+            },
             output_format: { type: "string", enum: ["text", "json", "docx"] },
             project: {
                 type: "string",