The costs and benefits of bowel cancer service developments using discrete event simulation

Abstract

Colorectal cancer includes cancerous growths in the colon, rectum and appendix and affects around 30 000 people in England each year. Maximizing health benefits for patients with colorectal cancer requires consideration of costs and outcomes across the whole service. In an era of scarce healthcare resources, there is a need to consider not only whether technologies and services may be considered clinically effective, but also whether they are cost-effective, that is, whether they represent value for money for the health service. Through the development of a whole disease model, it is possible to evaluate the cost-effectiveness of a range of options for service development consistently within a common framework. Discrete event simulation has been used to model the complete colorectal cancer patient pathway from patient presentation through to referral and diagnosis, treatment, follow-up, potential recurrence, treatment of metastases and end-of-life care. This simulation model has been used to examine the potential cost-effectiveness of different options for change across the entire colorectal cancer pathway. This paper provides an empirical demonstration of the potential application of modelling entire disease areas to inform clinical policy and resource allocation decision-making.

Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project

“…6 More recently, the Department of Health funded the development of a guideline-like clinical care pathway model for colorectal cancer. 48 This also used DES to model current practice, following patients from initial presentation with suspected colorectal cancer through to end-of-life care. The simulation model was then used to provide a baseline for estimation of the cost-effectiveness of a range of potential (largely hypothetical) service developments.…”

“…Building on the work of Pilgrim and colleagues, 48 Tappenden and colleagues 49 later developed a methods framework for developing and using Whole Disease Models to inform resource allocation decisions in cancer. This methods framework was then applied to inform the development of a Colorectal Cancer Whole Disease Model to examine its potential value in supporting economic analysis within the NICE CG on the diagnosis and management of colorectal cancer (CG131).…”

“…This has been suggested as a means of strengthening the analytical foundation of NICE CGs in order to apply the Institute's decision-making principles. 6 Several generic disease models that could fulfil such a function have been reported previously, 41,42,44,46,48 and a methodological framework on how to design, build, check and apply 'Whole Disease Models' has been published. 49 Tappenden and colleagues 63 have also demonstrated how this concept could be applied to CGs by showing how their Whole Disease Model of colorectal cancer could evaluate 11 of the 15 topics addressed in the NICE colorectal cancer guideline.…”

Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation

“…These costs were taken from the study by Pilgrim and colleagues 140 and have been inflated to 2015 prices using The Hospital and Community Health Service index 124 (Table 43).…”

Scenario Analysis, Decision Trees and Simulation for Cost Benefit Analysis of the Cargo Screening Process

“…The authors use a micro simulation approach to explore different scenarios and their outputs. Similar to Habbema et al (1987) Pilgrim et al (2009) suggest conducting a cost effectiveness analysis for cancer screening policies while using discrete event simulation. The authors support their choice of methodology with previous research using the same research strategy.…”