heor-agent-mcp 1.5.1 → 1.6.0

package/dist/formatters/xlsx.d.ts

@@ -6,14 +6,16 @@
  * 2. Modify assumptions
  * 3. Submit to HTA bodies
  *
- * Workbooks use formulas (not static values) so inputs can be changed and
- * results recalculate. Multi-tab structure: Inputs, Model, Results, PSA, Audit.
+ * Workbooks use live Excel formulas so inputs can be changed and
+ * results recalculate. Multi-tab structure: Summary, Inputs, Transition Matrix,
+ * Markov Trace, PSA, CEAC, Audit.
  */
 import type { CEModelParams, CEModelResult } from "../providers/types.js";
 import type { AuditRecord } from "../audit/types.js";
 /**
  * Build a cost-effectiveness model Excel workbook.
- * Inputs are editable (yellow), formulas are read-only (blue).
+ * Inputs are editable (yellow); formula cells (blue) update automatically
+ * when Inputs values are changed and the workbook is saved/recalculated.
  */
 export declare function ceModelToXlsx(params: CEModelParams, result: CEModelResult, audit: AuditRecord): Promise<Buffer>;
 /**

package/dist/formatters/xlsx.d.ts.map

@@ -1 +1 @@
-{"version":3,"file":"xlsx.d.ts","sourceRoot":"","sources":["../../src/formatters/xlsx.ts"],"names":[],"mappings":"AAAA;;;;;;;;;;GAUG;AAGH,OAAO,KAAK,EAAE,aAAa,EAAE,aAAa,EAAE,MAAM,uBAAuB,CAAC;AAC1E,OAAO,KAAK,EAAE,WAAW,EAAE,MAAM,mBAAmB,CAAC;AAsCrD;;;GAGG;AACH,wBAAsB,aAAa,CACjC,MAAM,EAAE,aAAa,EACrB,MAAM,EAAE,aAAa,EACrB,KAAK,EAAE,WAAW,GACjB,OAAO,CAAC,MAAM,CAAC,CAgUjB;AAED;;GAEG;AACH,wBAAsB,SAAS,CAC7B,MAAM,EAAE,MAAM,CAAC,MAAM,EAAE,OAAO,CAAC,EAC/B,OAAO,EAAE,KAAK,CAAC;IACb,IAAI,EAAE,MAAM,CAAC;IACb,mBAAmB,EAAE,MAAM,CAAC;IAC5B,kBAAkB,EAAE,MAAM,CAAC;IAC3B,iBAAiB,EAAE,MAAM,CAAC;IAC1B,eAAe,EAAE,MAAM,CAAC;IACxB,oBAAoB,EAAE,MAAM,CAAC;IAC7B,iBAAiB,EAAE,MAAM,CAAC;IAC1B,gBAAgB,EAAE,MAAM,CAAC;CAC1B,CAAC,EACF,KAAK,EAAE,WAAW,GACjB,OAAO,CAAC,MAAM,CAAC,CAyLjB"}
+{"version":3,"file":"xlsx.d.ts","sourceRoot":"","sources":["../../src/formatters/xlsx.ts"],"names":[],"mappings":"AAAA;;;;;;;;;;;GAWG;AAGH,OAAO,KAAK,EAAE,aAAa,EAAE,aAAa,EAAE,MAAM,uBAAuB,CAAC;AAC1E,OAAO,KAAK,EAAE,WAAW,EAAE,MAAM,mBAAmB,CAAC;AA6CrD;;;;GAIG;AACH,wBAAsB,aAAa,CACjC,MAAM,EAAE,aAAa,EACrB,MAAM,EAAE,aAAa,EACrB,KAAK,EAAE,WAAW,GACjB,OAAO,CAAC,MAAM,CAAC,CAipBjB;AAED;;GAEG;AACH,wBAAsB,SAAS,CAC7B,MAAM,EAAE,MAAM,CAAC,MAAM,EAAE,OAAO,CAAC,EAC/B,OAAO,EAAE,KAAK,CAAC;IACb,IAAI,EAAE,MAAM,CAAC;IACb,mBAAmB,EAAE,MAAM,CAAC;IAC5B,kBAAkB,EAAE,MAAM,CAAC;IAC3B,iBAAiB,EAAE,MAAM,CAAC;IAC1B,eAAe,EAAE,MAAM,CAAC;IACxB,oBAAoB,EAAE,MAAM,CAAC;IAC7B,iBAAiB,EAAE,MAAM,CAAC;IAC1B,gBAAgB,EAAE,MAAM,CAAC;CAC1B,CAAC,EACF,KAAK,EAAE,WAAW,GACjB,OAAO,CAAC,MAAM,CAAC,CAqNjB"}

package/dist/formatters/xlsx.js

@@ -6,8 +6,9 @@
  * 2. Modify assumptions
  * 3. Submit to HTA bodies
  *
- * Workbooks use formulas (not static values) so inputs can be changed and
- * results recalculate. Multi-tab structure: Inputs, Model, Results, PSA, Audit.
+ * Workbooks use live Excel formulas so inputs can be changed and
+ * results recalculate. Multi-tab structure: Summary, Inputs, Transition Matrix,
+ * Markov Trace, PSA, CEAC, Audit.
  */
 import ExcelJS from "exceljs";
 const HEADER_FILL = {
@@ -41,9 +42,19 @@ function styleHeaderCell(cell) {
         right: { style: "thin" },
     };
 }
+function getNCycles(time_horizon) {
+    if (time_horizon === "lifetime")
+        return 40;
+    if (time_horizon === "5yr")
+        return 5;
+    if (time_horizon === "10yr")
+        return 10;
+    return Number(time_horizon);
+}
 /**
  * Build a cost-effectiveness model Excel workbook.
- * Inputs are editable (yellow), formulas are read-only (blue).
+ * Inputs are editable (yellow); formula cells (blue) update automatically
+ * when Inputs values are changed and the workbook is saved/recalculated.
  */
 export async function ceModelToXlsx(params, result, audit) {
     const wb = new ExcelJS.Workbook();
@@ -52,6 +63,15 @@ export async function ceModelToXlsx(params, result, audit) {
     const perspective = params.perspective;
     const currency = perspective === "nhs" ? "GBP" : "USD";
     const symbol = perspective === "nhs" ? "£" : "$";
+    const n_cycles = getNCycles(params.time_horizon);
+    // Precompute transition probabilities (needed for result caching in formula cells)
+    const efficacyDelta = Math.max(0, Math.min(0.999, params.clinical_inputs.efficacy_delta));
+    const mortalityReduction = params.clinical_inputs.mortality_reduction ?? 0;
+    const baseMortality = 0.02;
+    const interventionMortality = Math.max(0.005, baseMortality * (1 - mortalityReduction));
+    const comparatorMortality = baseMortality;
+    const probStayOnIntervention = Math.max(0.05, Math.min(0.93, 0.5 + efficacyDelta * 0.5));
+    const baselineProbStayOn = Math.max(0.05, Math.min(0.88, probStayOnIntervention * 0.7));
     // --- Tab 1: Summary ---
     const summary = wb.addWorksheet("Summary");
     summary.columns = [
@@ -60,7 +80,7 @@ export async function ceModelToXlsx(params, result, audit) {
     ];
     styleHeaderCell(summary.getCell("A1"));
     styleHeaderCell(summary.getCell("B1"));
-    const rows = [
+    const staticRows = [
         ["Intervention", params.intervention],
         ["Comparator", params.comparator],
         ["Indication", params.indication],
@@ -70,34 +90,79 @@ export async function ceModelToXlsx(params, result, audit) {
         ["Model Type", params.model_type ?? "markov"],
         ["Discount Rate", 0.035],
         ["", ""],
-        [
-            "ICER",
-            isFinite(result.base_case.icer) ? result.base_case.icer : "Dominated",
-        ],
-        ["Delta Cost", result.base_case.delta_cost],
-        ["Delta QALY", result.base_case.delta_qaly],
-        ["Incremental Life Years", result.base_case.incremental_lys],
-        ["Total Cost Intervention", result.base_case.total_cost_intervention],
-        ["Total Cost Comparator", result.base_case.total_cost_comparator],
-        ["Total QALYs Intervention", result.base_case.total_qaly_intervention],
-        ["Total QALYs Comparator", result.base_case.total_qaly_comparator],
     ];
-    rows.forEach(([metric, value], i) => {
+    staticRows.forEach(([metric, value], i) => {
         const row = summary.getRow(i + 2);
         row.getCell(1).value = metric;
         row.getCell(2).value = value;
-        if ((typeof value === "number" && metric.includes("Cost")) ||
-            metric === "ICER") {
-            row.getCell(2).numFmt = `"${symbol}"#,##0`;
-        }
-        else if (typeof value === "number" &&
-            (metric.includes("QALY") || metric.includes("Life Years"))) {
-            row.getCell(2).numFmt = "0.000";
-        }
-        else if (metric === "Discount Rate") {
+        if (metric === "Discount Rate") {
             row.getCell(2).numFmt = "0.0%";
         }
     });
+    // Rows 11-18: formula cells referencing Markov Trace
+    const lastTraceRow = 2 + n_cycles; // row 2 = cycle 0, row 2+n_cycles = last cycle
+    // Row 11: ICER
+    summary.getRow(11).getCell(1).value = "ICER";
+    summary.getRow(11).getCell(2).value = {
+        formula: `=IF(B13=0,"Dominated",B12/B13)`,
+        result: isFinite(result.base_case.icer)
+            ? result.base_case.icer
+            : "Dominated",
+    };
+    summary.getRow(11).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(11).getCell(2).fill = FORMULA_FILL;
+    // Row 12: Delta Cost
+    summary.getRow(12).getCell(1).value = "Delta Cost";
+    summary.getRow(12).getCell(2).value = {
+        formula: `=B15-B16`,
+        result: result.base_case.delta_cost,
+    };
+    summary.getRow(12).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(12).getCell(2).fill = FORMULA_FILL;
+    // Row 13: Delta QALY
+    summary.getRow(13).getCell(1).value = "Delta QALY";
+    summary.getRow(13).getCell(2).value = {
+        formula: `=B17-B18`,
+        result: result.base_case.delta_qaly,
+    };
+    summary.getRow(13).getCell(2).numFmt = "0.000";
+    summary.getRow(13).getCell(2).fill = FORMULA_FILL;
+    // Row 14: Incremental Life Years — keep static (complex lifecycle, minor value)
+    summary.getRow(14).getCell(1).value = "Incremental Life Years";
+    summary.getRow(14).getCell(2).value = result.base_case.incremental_lys;
+    summary.getRow(14).getCell(2).numFmt = "0.000";
+    // Row 15: Total Cost Intervention
+    summary.getRow(15).getCell(1).value = "Total Cost Intervention";
+    summary.getRow(15).getCell(2).value = {
+        formula: `=SUM('Markov Trace'!$I$2:$I$${lastTraceRow})`,
+        result: result.base_case.total_cost_intervention,
+    };
+    summary.getRow(15).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(15).getCell(2).fill = FORMULA_FILL;
+    // Row 16: Total Cost Comparator
+    summary.getRow(16).getCell(1).value = "Total Cost Comparator";
+    summary.getRow(16).getCell(2).value = {
+        formula: `=SUM('Markov Trace'!$J$2:$J$${lastTraceRow})`,
+        result: result.base_case.total_cost_comparator,
+    };
+    summary.getRow(16).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(16).getCell(2).fill = FORMULA_FILL;
+    // Row 17: Total QALYs Intervention
+    summary.getRow(17).getCell(1).value = "Total QALYs Intervention";
+    summary.getRow(17).getCell(2).value = {
+        formula: `=SUM('Markov Trace'!$L$2:$L$${lastTraceRow})`,
+        result: result.base_case.total_qaly_intervention,
+    };
+    summary.getRow(17).getCell(2).numFmt = "0.000";
+    summary.getRow(17).getCell(2).fill = FORMULA_FILL;
+    // Row 18: Total QALYs Comparator
+    summary.getRow(18).getCell(1).value = "Total QALYs Comparator";
+    summary.getRow(18).getCell(2).value = {
+        formula: `=SUM('Markov Trace'!$M$2:$M$${lastTraceRow})`,
+        result: result.base_case.total_qaly_comparator,
+    };
+    summary.getRow(18).getCell(2).numFmt = "0.000";
+    summary.getRow(18).getCell(2).fill = FORMULA_FILL;
     // --- Tab 2: Inputs (editable) ---
     const inputs = wb.addWorksheet("Inputs");
     inputs.columns = [
@@ -159,6 +224,11 @@ export async function ceModelToXlsx(params, result, audit) {
         ["Discount rate (costs)", 0.035, "annual %", "NICE reference case"],
         ["Discount rate (outcomes)", 0.035, "annual %", "NICE reference case"],
     ];
+    // Inputs row mapping (1-based after header):
+    // B2 = drug_cost_annual, B3 = comparator_cost_annual, B4 = admin_cost, B5 = ae_cost
+    // B6 = efficacy_delta, B7 = mortality_reduction
+    // B8 = qaly_on_treatment, B9 = qaly_comparator
+    // B10 = discount_rate_costs, B11 = discount_rate_outcomes
     inputRows.forEach(([param, value, unit, notes], i) => {
         const row = inputs.getRow(i + 2);
         row.getCell(1).value = param;
@@ -174,21 +244,12 @@ export async function ceModelToXlsx(params, result, audit) {
             row.getCell(2).numFmt = "0.000";
     });
     inputs.getRow(inputRows.length + 3).getCell(1).value =
-        "Inputs shown for transparency. To re-run with modified values, call the cost_effectiveness_model tool again — editing this sheet does not recalculate results.";
+        "Inputs are linked to the Markov Trace, Transition Matrix, Results, and CEAC sheets — edit any value and save to trigger Excel recalculation.";
     inputs.getRow(inputRows.length + 3).getCell(1).font = {
         italic: true,
         color: { argb: "FF666666" },
     };
-    // --- Tab 3: Transition Matrix ---
-    // Derive actual transition probabilities from model params (same logic as
-    // src/models/modelUtils.ts buildMarkovParamsFromCE).
-    const efficacyDelta = Math.max(0, Math.min(0.999, params.clinical_inputs.efficacy_delta));
-    const mortalityReduction = params.clinical_inputs.mortality_reduction ?? 0;
-    const baseMortality = 0.02;
-    const interventionMortality = Math.max(0.005, baseMortality * (1 - mortalityReduction));
-    const comparatorMortality = baseMortality;
-    const probStayOnIntervention = Math.max(0.05, Math.min(0.93, 0.5 + efficacyDelta * 0.5));
-    const baselineProbStayOn = Math.max(0.05, Math.min(0.88, probStayOnIntervention * 0.7));
+    // --- Tab 3: Transition Matrix (formula cells referencing Inputs) ---
     const trans = wb.addWorksheet("Transition Matrix");
     trans.columns = [
         { header: "From \\ To", key: "state", width: 20 },
@@ -197,54 +258,284 @@ export async function ceModelToXlsx(params, result, audit) {
         { header: "Dead", key: "dead", width: 16 },
     ];
     ["A1", "B1", "C1", "D1"].forEach((c) => styleHeaderCell(trans.getCell(c)));
-    trans.getRow(2).values = [
-        "On-Treatment (Intervention)",
-        probStayOnIntervention,
-        Math.max(0, 1 - probStayOnIntervention - interventionMortality),
-        interventionMortality,
-    ];
-    trans.getRow(3).values = [
-        "Off-Treatment (Intervention)",
-        0.05,
-        Math.max(0, 0.95 - interventionMortality),
-        interventionMortality,
-    ];
+    // Row 2: On-Treatment (Intervention)
+    trans.getRow(2).getCell(1).value = "On-Treatment (Intervention)";
+    trans.getRow(2).getCell(2).value = {
+        formula: `=MIN(0.93,MAX(0.05,0.5+Inputs!$B$6*0.5))`,
+        result: probStayOnIntervention,
+    };
+    trans.getRow(2).getCell(2).fill = FORMULA_FILL;
+    trans.getRow(2).getCell(3).value = {
+        formula: `=MAX(0,1-B2-MAX(0.005,0.02*(1-Inputs!$B$7)))`,
+        result: Math.max(0, 1 - probStayOnIntervention - interventionMortality),
+    };
+    trans.getRow(2).getCell(3).fill = FORMULA_FILL;
+    trans.getRow(2).getCell(4).value = {
+        formula: `=MAX(0.005,0.02*(1-Inputs!$B$7))`,
+        result: interventionMortality,
+    };
+    trans.getRow(2).getCell(4).fill = FORMULA_FILL;
+    // Row 3: Off-Treatment (Intervention)
+    trans.getRow(3).getCell(1).value = "Off-Treatment (Intervention)";
+    trans.getRow(3).getCell(2).value = {
+        formula: `=0.05`,
+        result: 0.05,
+    };
+    trans.getRow(3).getCell(2).fill = FORMULA_FILL;
+    trans.getRow(3).getCell(3).value = {
+        formula: `=MAX(0,0.95-MAX(0.005,0.02*(1-Inputs!$B$7)))`,
+        result: Math.max(0, 0.95 - interventionMortality),
+    };
+    trans.getRow(3).getCell(3).fill = FORMULA_FILL;
+    trans.getRow(3).getCell(4).value = {
+        formula: `=MAX(0.005,0.02*(1-Inputs!$B$7))`,
+        result: interventionMortality,
+    };
+    trans.getRow(3).getCell(4).fill = FORMULA_FILL;
+    // Row 4: Dead (Intervention) — static
     trans.getRow(4).values = ["Dead", 0, 0, 1];
+    // Row 5: empty separator
     trans.getRow(5).values = [""];
-    trans.getRow(6).values = [
-        "On-Treatment (Comparator)",
-        baselineProbStayOn,
-        Math.max(0, 1 - baselineProbStayOn - comparatorMortality),
-        comparatorMortality,
-    ];
-    trans.getRow(7).values = [
-        "Off-Treatment (Comparator)",
-        0.05,
-        Math.max(0, 0.95 - comparatorMortality),
-        comparatorMortality,
-    ];
+    // Row 6: On-Treatment (Comparator)
+    trans.getRow(6).getCell(1).value = "On-Treatment (Comparator)";
+    trans.getRow(6).getCell(2).value = {
+        formula: `=MIN(0.88,MAX(0.05,MIN(0.93,MAX(0.05,0.5+Inputs!$B$6*0.5))*0.7))`,
+        result: baselineProbStayOn,
+    };
+    trans.getRow(6).getCell(2).fill = FORMULA_FILL;
+    trans.getRow(6).getCell(3).value = {
+        formula: `=MAX(0,1-B6-0.02)`,
+        result: Math.max(0, 1 - baselineProbStayOn - comparatorMortality),
+    };
+    trans.getRow(6).getCell(3).fill = FORMULA_FILL;
+    trans.getRow(6).getCell(4).value = 0.02;
+    // Row 7: Off-Treatment (Comparator)
+    trans.getRow(7).getCell(1).value = "Off-Treatment (Comparator)";
+    trans.getRow(7).getCell(2).value = {
+        formula: `=0.05`,
+        result: 0.05,
+    };
+    trans.getRow(7).getCell(2).fill = FORMULA_FILL;
+    trans.getRow(7).getCell(3).value = {
+        formula: `=MAX(0,0.95-0.02)`,
+        result: 0.93,
+    };
+    trans.getRow(7).getCell(3).fill = FORMULA_FILL;
+    trans.getRow(7).getCell(4).value = 0.02;
+    // Row 8: Dead (Comparator) — static
     trans.getRow(8).values = ["Dead", 0, 0, 1];
+    // Apply number format to all data cells
     for (let r = 2; r <= 8; r++) {
         for (let c = 2; c <= 4; c++) {
             const cell = trans.getRow(r).getCell(c);
-            if (typeof cell.value === "number") {
+            if (cell.value !== undefined && cell.value !== "") {
                 cell.numFmt = "0.0000";
             }
         }
     }
     trans.getRow(10).getCell(1).value =
-        "Transition probabilities derived from efficacy_delta and mortality_reduction inputs. Values are read-only for transparency — modify efficacy_delta on the Inputs tab to change them.";
+        "Rows must sum to 1.0. Formulas reference Inputs tab — edit efficacy_delta or mortality_reduction to update.";
     trans.getRow(10).getCell(1).font = {
         italic: true,
         color: { argb: "FF666666" },
     };
-    trans.getRow(10).getCell(1).value =
-        "Rows must sum to 1.0. Editable — modify to reflect trial-specific transitions.";
-    trans.getRow(10).getCell(1).font = {
-        italic: true,
-        color: { argb: "FF666666" },
+    // --- Tab 4: Markov Trace (NEW — live formulas for state populations and discounted costs/QALYs) ---
+    const traceSheet = wb.addWorksheet("Markov Trace");
+    traceSheet.columns = [
+        { header: "Cycle", key: "cycle", width: 8 },
+        { header: "Int-On", key: "i_on", width: 12 },
+        { header: "Int-Off", key: "i_off", width: 12 },
+        { header: "Int-Dead", key: "i_dead", width: 12 },
+        { header: "Comp-On", key: "c_on", width: 12 },
+        { header: "Comp-Off", key: "c_off", width: 12 },
+        { header: "Comp-Dead", key: "c_dead", width: 12 },
+        { header: "Cost Disc Factor", key: "hdf", width: 18 },
+        { header: "Int Disc Cost", key: "idc", width: 18 },
+        { header: "Comp Disc Cost", key: "cdc", width: 18 },
+        { header: "QALY Disc Factor", key: "kdf", width: 18 },
+        { header: "Int Disc QALY", key: "idq", width: 18 },
+        { header: "Comp Disc QALY", key: "cdq", width: 18 },
+    ];
+    for (let c = 1; c <= 13; c++) {
+        styleHeaderCell(traceSheet.getRow(1).getCell(c));
+    }
+    // Row 2: Cycle 0 (initial state)
+    // Precompute initial discounted cost/QALY for result caching
+    const drugCost = params.cost_inputs.drug_cost_annual;
+    const comparatorCost = params.cost_inputs.comparator_cost_annual;
+    const adminCost = params.cost_inputs.admin_cost ?? 0;
+    const qalyOnTx = params.utility_inputs?.qaly_on_treatment ?? 0.75;
+    const qalyComparator = params.utility_inputs?.qaly_comparator ?? 0.7;
+    const initIntDiscCost = drugCost + adminCost; // cycle 0: 100% On-Treatment
+    const initCompDiscCost = comparatorCost + adminCost;
+    const initIntDiscQaly = qalyOnTx; // cycle 0: 100% On-Treatment
+    const initCompDiscQaly = qalyOnTx; // cycle 0: comparator also starts On-Treatment
+    traceSheet.getRow(2).getCell(1).value = 0; // cycle
+    traceSheet.getRow(2).getCell(2).value = 1; // Int-On = 1
+    traceSheet.getRow(2).getCell(3).value = 0; // Int-Off = 0
+    traceSheet.getRow(2).getCell(4).value = 0; // Int-Dead = 0
+    traceSheet.getRow(2).getCell(5).value = 1; // Comp-On = 1
+    traceSheet.getRow(2).getCell(6).value = 0; // Comp-Off = 0
+    traceSheet.getRow(2).getCell(7).value = 0; // Comp-Dead = 0
+    // H2: cost discount factor at cycle 0 = 1
+    traceSheet.getRow(2).getCell(8).value = { formula: `=1`, result: 1 };
+    traceSheet.getRow(2).getCell(8).fill = FORMULA_FILL;
+    // I2: Int discounted cost at cycle 0
+    traceSheet.getRow(2).getCell(9).value = {
+        formula: `=H2*(B2*(Inputs!$B$2+Inputs!$B$4))`,
+        result: initIntDiscCost,
+    };
+    traceSheet.getRow(2).getCell(9).fill = FORMULA_FILL;
+    // J2: Comp discounted cost at cycle 0
+    traceSheet.getRow(2).getCell(10).value = {
+        formula: `=H2*(E2*(Inputs!$B$3+Inputs!$B$4))`,
+        result: initCompDiscCost,
+    };
+    traceSheet.getRow(2).getCell(10).fill = FORMULA_FILL;
+    // K2: QALY discount factor at cycle 0 = 1
+    traceSheet.getRow(2).getCell(11).value = { formula: `=1`, result: 1 };
+    traceSheet.getRow(2).getCell(11).fill = FORMULA_FILL;
+    // L2: Int discounted QALY at cycle 0
+    traceSheet.getRow(2).getCell(12).value = {
+        formula: `=K2*(B2*Inputs!$B$8+C2*Inputs!$B$9)`,
+        result: initIntDiscQaly,
     };
-    // --- Tab 4: PSA Iterations ---
+    traceSheet.getRow(2).getCell(12).fill = FORMULA_FILL;
+    // M2: Comp discounted QALY at cycle 0
+    traceSheet.getRow(2).getCell(13).value = {
+        formula: `=K2*(E2*Inputs!$B$8+F2*Inputs!$B$9)`,
+        result: initCompDiscQaly,
+    };
+    traceSheet.getRow(2).getCell(13).fill = FORMULA_FILL;
+    // Apply number formats to row 2
+    traceSheet.getRow(2).getCell(9).numFmt = `"${symbol}"#,##0`;
+    traceSheet.getRow(2).getCell(10).numFmt = `"${symbol}"#,##0`;
+    traceSheet.getRow(2).getCell(12).numFmt = "0.000";
+    traceSheet.getRow(2).getCell(13).numFmt = "0.000";
+    // Rows 3..n_cycles+2: one row per cycle 1..n_cycles
+    // Precompute Markov trace for result caching
+    let intOn = 1, intOff = 0, intDead = 0;
+    let compOn = 1, compOff = 0, compDead = 0;
+    let costDiscFactor = 1;
+    let qalyDiscFactor = 1;
+    const discRateCosts = 0.035;
+    const discRateOutcomes = 0.035;
+    // Transition probabilities (precomputed)
+    const pIntOnOn = probStayOnIntervention;
+    const pIntOffOn = 0.05;
+    const pIntOnOff = Math.max(0, 1 - probStayOnIntervention - interventionMortality);
+    const pIntOffOff = Math.max(0, 0.95 - interventionMortality);
+    const pIntOnDead = interventionMortality;
+    const pIntOffDead = interventionMortality;
+    const pCompOnOn = baselineProbStayOn;
+    const pCompOffOn = 0.05;
+    const pCompOnOff = Math.max(0, 1 - baselineProbStayOn - comparatorMortality);
+    const pCompOffOff = Math.max(0, 0.95 - comparatorMortality);
+    const pCompOnDead = comparatorMortality;
+    const pCompOffDead = comparatorMortality;
+    for (let cycle = 1; cycle <= n_cycles; cycle++) {
+        const r = cycle + 2; // Excel row number
+        const prev = r - 1;
+        // Apply transitions for caching
+        costDiscFactor = costDiscFactor * (1 / (1 + discRateCosts));
+        qalyDiscFactor = qalyDiscFactor * (1 / (1 + discRateOutcomes));
+        const newIntOn = pIntOnOn * intOn + pIntOffOn * intOff; // Dead stays dead → 0 contribution
+        const newIntOff = pIntOnOff * intOn + pIntOffOff * intOff;
+        const newIntDead = pIntOnDead * intOn + pIntOffDead * intOff + intDead;
+        intOn = newIntOn;
+        intOff = newIntOff;
+        intDead = newIntDead;
+        const newCompOn = pCompOnOn * compOn + pCompOffOn * compOff;
+        const newCompOff = pCompOnOff * compOn + pCompOffOff * compOff;
+        const newCompDead = pCompOnDead * compOn + pCompOffDead * compOff + compDead;
+        compOn = newCompOn;
+        compOff = newCompOff;
+        compDead = newCompDead;
+        const intDiscCost = costDiscFactor * (intOn * (drugCost + adminCost));
+        const compDiscCost = costDiscFactor * (compOn * (comparatorCost + adminCost));
+        const intDiscQaly = qalyDiscFactor * (intOn * qalyOnTx + intOff * qalyComparator);
+        const compDiscQaly = qalyDiscFactor * (compOn * qalyOnTx + compOff * qalyComparator);
+        const row = traceSheet.getRow(r);
+        // A: cycle number
+        row.getCell(1).value = cycle;
+        // B: Int-On
+        row.getCell(2).value = {
+            formula: `='Transition Matrix'!$B$2*B${prev}+'Transition Matrix'!$B$3*C${prev}+'Transition Matrix'!$B$4*D${prev}`,
+            result: intOn,
+        };
+        row.getCell(2).fill = FORMULA_FILL;
+        // C: Int-Off
+        row.getCell(3).value = {
+            formula: `='Transition Matrix'!$C$2*B${prev}+'Transition Matrix'!$C$3*C${prev}+'Transition Matrix'!$C$4*D${prev}`,
+            result: intOff,
+        };
+        row.getCell(3).fill = FORMULA_FILL;
+        // D: Int-Dead
+        row.getCell(4).value = {
+            formula: `='Transition Matrix'!$D$2*B${prev}+'Transition Matrix'!$D$3*C${prev}+'Transition Matrix'!$D$4*D${prev}`,
+            result: intDead,
+        };
+        row.getCell(4).fill = FORMULA_FILL;
+        // E: Comp-On
+        row.getCell(5).value = {
+            formula: `='Transition Matrix'!$B$6*E${prev}+'Transition Matrix'!$B$7*F${prev}+'Transition Matrix'!$B$8*G${prev}`,
+            result: compOn,
+        };
+        row.getCell(5).fill = FORMULA_FILL;
+        // F: Comp-Off
+        row.getCell(6).value = {
+            formula: `='Transition Matrix'!$C$6*E${prev}+'Transition Matrix'!$C$7*F${prev}+'Transition Matrix'!$C$8*G${prev}`,
+            result: compOff,
+        };
+        row.getCell(6).fill = FORMULA_FILL;
+        // G: Comp-Dead
+        row.getCell(7).value = {
+            formula: `='Transition Matrix'!$D$6*E${prev}+'Transition Matrix'!$D$7*F${prev}+'Transition Matrix'!$D$8*G${prev}`,
+            result: compDead,
+        };
+        row.getCell(7).fill = FORMULA_FILL;
+        // H: Cost discount factor (recurrence)
+        row.getCell(8).value = {
+            formula: `=H${prev}*(1/(1+Inputs!$B$10))`,
+            result: costDiscFactor,
+        };
+        row.getCell(8).fill = FORMULA_FILL;
+        // I: Int discounted cost
+        row.getCell(9).value = {
+            formula: `=H${r}*(B${r}*(Inputs!$B$2+Inputs!$B$4))`,
+            result: intDiscCost,
+        };
+        row.getCell(9).fill = FORMULA_FILL;
+        row.getCell(9).numFmt = `"${symbol}"#,##0`;
+        // J: Comp discounted cost
+        row.getCell(10).value = {
+            formula: `=H${r}*(E${r}*(Inputs!$B$3+Inputs!$B$4))`,
+            result: compDiscCost,
+        };
+        row.getCell(10).fill = FORMULA_FILL;
+        row.getCell(10).numFmt = `"${symbol}"#,##0`;
+        // K: QALY discount factor (recurrence)
+        row.getCell(11).value = {
+            formula: `=K${prev}*(1/(1+Inputs!$B$11))`,
+            result: qalyDiscFactor,
+        };
+        row.getCell(11).fill = FORMULA_FILL;
+        // L: Int discounted QALY
+        row.getCell(12).value = {
+            formula: `=K${r}*(B${r}*Inputs!$B$8+C${r}*Inputs!$B$9)`,
+            result: intDiscQaly,
+        };
+        row.getCell(12).fill = FORMULA_FILL;
+        row.getCell(12).numFmt = "0.000";
+        // M: Comp discounted QALY
+        row.getCell(13).value = {
+            formula: `=K${r}*(E${r}*Inputs!$B$8+F${r}*Inputs!$B$9)`,
+            result: compDiscQaly,
+        };
+        row.getCell(13).fill = FORMULA_FILL;
+        row.getCell(13).numFmt = "0.000";
+    }
+    // --- Tab 5: PSA Iterations ---
     if (result.psa && result.psa.scatter.length > 0) {
         const psaSheet = wb.addWorksheet("PSA");
         psaSheet.columns = [
@@ -291,7 +582,7 @@ export async function ceModelToXlsx(params, result, audit) {
         psaSheet.getRow(summaryRow + 1).getCell(1).font = { bold: true };
         psaSheet.getRow(summaryRow + 1).getCell(2).numFmt = `"${symbol}"#,##0`;
     }
-    // --- Tab 5: CEAC ---
+    // --- Tab 6: CEAC (COUNTIF formulas referencing PSA sheet) ---
     if (result.psa && result.psa.ceac.length > 0) {
         const ceacSheet = wb.addWorksheet("CEAC");
         ceacSheet.columns = [
@@ -299,15 +590,21 @@ export async function ceModelToXlsx(params, result, audit) {
             { header: "P(cost-effective)", key: "p", width: 20 },
         ];
         ["A1", "B1"].forEach((c) => styleHeaderCell(ceacSheet.getCell(c)));
+        const n_psa = result.psa.scatter.length;
+        const lastPSARow = n_psa + 1;
         result.psa.ceac.forEach((pt, i) => {
             const row = ceacSheet.getRow(i + 2);
             row.getCell(1).value = pt.wtp;
-            row.getCell(2).value = pt.prob_ce;
             row.getCell(1).numFmt = `"${symbol}"#,##0`;
+            row.getCell(2).value = {
+                formula: `=COUNTIFS(PSA!$D$2:PSA!$D$${lastPSARow},"<>N/A",PSA!$D$2:PSA!$D$${lastPSARow},"<="&A${i + 2})/${n_psa}`,
+                result: pt.prob_ce,
+            };
+            row.getCell(2).fill = FORMULA_FILL;
             row.getCell(2).numFmt = "0.00%";
         });
     }
-    // --- Tab 6: Audit ---
+    // --- Tab 7: Audit ---
     const auditSheet = wb.addWorksheet("Audit");
     auditSheet.columns = [
         { header: "Field", key: "field", width: 25 },
@@ -340,6 +637,9 @@ export async function bimToXlsx(params, results, audit) {
     wb.created = new Date();
     const perspective = params.perspective ?? "nhs";
     const symbol = perspective === "nhs" ? "£" : "$";
+    const totalNet = results.reduce((s, r) => s + r.net_budget_impact, 0);
+    const totalTreated = results.reduce((s, r) => s + r.treated_population, 0);
+    const dataLastRow = results.length + 1; // last data row in Year-by-Year (1-based, row 2 = year 1)
     // --- Tab 1: Summary ---
     const summary = wb.addWorksheet("Summary");
     summary.columns = [
@@ -348,8 +648,6 @@ export async function bimToXlsx(params, results, audit) {
     ];
     styleHeaderCell(summary.getCell("A1"));
     styleHeaderCell(summary.getCell("B1"));
-    const totalNet = results.reduce((s, r) => s + r.net_budget_impact, 0);
-    const totalTreated = results.reduce((s, r) => s + r.treated_population, 0);
     [
         ["Intervention", params.intervention],
         ["Comparator", params.comparator],
@@ -358,21 +656,35 @@ export async function bimToXlsx(params, results, audit) {
         ["Time Horizon (years)", results.length],
         ["Eligible Population (Year 1)", params.eligible_population],
         ["", ""],
-        ["Total Net Budget Impact", totalNet],
-        ["Total Patients Treated", totalTreated],
-        ["Average Net Cost per Patient", totalNet / (totalTreated || 1)],
     ].forEach((r, i) => {
         const row = summary.getRow(i + 2);
         row.getCell(1).value = r[0];
         row.getCell(2).value = r[1];
-        const metric = r[0];
-        if (metric.includes("Cost") || metric.includes("Impact")) {
-            row.getCell(2).numFmt = `"${symbol}"#,##0`;
-        }
-        else if (metric.includes("Population") || metric.includes("Patients")) {
-            row.getCell(2).numFmt = "#,##0";
-        }
     });
+    // Row 9: Total Net Budget Impact — SUM formula referencing Year-by-Year
+    summary.getRow(9).getCell(1).value = "Total Net Budget Impact";
+    summary.getRow(9).getCell(2).value = {
+        formula: `=SUM('Year-by-Year'!H2:H${dataLastRow})`,
+        result: totalNet,
+    };
+    summary.getRow(9).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(9).getCell(2).fill = FORMULA_FILL;
+    // Row 10: Total Patients Treated
+    summary.getRow(10).getCell(1).value = "Total Patients Treated";
+    summary.getRow(10).getCell(2).value = {
+        formula: `=SUM('Year-by-Year'!C2:C${dataLastRow})`,
+        result: totalTreated,
+    };
+    summary.getRow(10).getCell(2).numFmt = "#,##0";
+    summary.getRow(10).getCell(2).fill = FORMULA_FILL;
+    // Row 11: Average Net Cost per Patient
+    summary.getRow(11).getCell(1).value = "Average Net Cost per Patient";
+    summary.getRow(11).getCell(2).value = {
+        formula: `=IF(B10=0,0,B9/B10)`,
+        result: totalTreated > 0 ? totalNet / totalTreated : 0,
+    };
+    summary.getRow(11).getCell(2).numFmt = `"${symbol}"#,##0`;
+    summary.getRow(11).getCell(2).fill = FORMULA_FILL;
     // --- Tab 2: Inputs (editable) ---
     const inputs = wb.addWorksheet("Inputs");
     inputs.columns = [
@@ -482,11 +794,20 @@ export async function bimToXlsx(params, results, audit) {
         for (let c = 5; c <= 9; c++)
             row.getCell(c).numFmt = `"${symbol}"#,##0`;
     });
-    // Total row
-    const totalRow = yearly.getRow(results.length + 2);
+    // Total row — SUM formulas
+    const totalRowNum = results.length + 2;
+    const totalRow = yearly.getRow(totalRowNum);
     totalRow.getCell(1).value = "Total";
-    totalRow.getCell(3).value = totalTreated;
-    totalRow.getCell(8).value = totalNet;
+    totalRow.getCell(3).value = {
+        formula: `=SUM(C2:C${dataLastRow})`,
+        result: totalTreated,
+    };
+    totalRow.getCell(3).fill = FORMULA_FILL;
+    totalRow.getCell(8).value = {
+        formula: `=SUM(H2:H${dataLastRow})`,
+        result: totalNet,
+    };
+    totalRow.getCell(8).fill = FORMULA_FILL;
     totalRow.font = { bold: true };
     totalRow.getCell(3).numFmt = "#,##0";
     totalRow.getCell(8).numFmt = `"${symbol}"#,##0`;