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Simulationmodelusetoinformcolorectalcancerscreeningdelivery:asystematicreviewSmith,Heather1,2;Varshoei,Peyman1;Boushey,Robin2;Kuziemsky,Craig11 TelferSchoolofManagement,UniversityofOttawa,55LaurierAveE,Ottawa,Ontario2DivisionofGeneralSurgery,TheOttawaHospital,Ottawa,Ontario
Difficulttoestimateresources&effectivenesslong-term
Colorectalcancer(CRC)&screening• 2ndhighestcancermortality.• Screeningdetectscancerearlier&improvesoutcomes.
• Optimal screeningpopulation,modality,frequency,&ageisdifficulttoassess:・Populationspecific・NofeasibleRCT
▶Background ▶Results
▶Acknowledgements&References
0
▶Conclusion
Simulationmodeling• Representationofahealthsystem.• Usedtoassessoptimalcancerscreening&complexhealthcaredelivery.
• Analyzescenarios&estimateoutcomestoinformdecision-making.
ThevalidityandimpactofsimulationmodelsusedtoinformCRCscreeningis
unknown.
SystematicreviewofnineacademicdatabasesJan2008-Mar2019.
InclusionCriteria:• Simulationmodelincorporatingclinicaldata,
• TargetaverageriskcolorectalcancerscreeningdeliveryusingFIT,FS,FOBTorcolonoscopy✝.
✝ FIT(fecalimmunohistochemicaltesting),FS(flexiblesigmoidoscopy),FOBT(fecaloccultbloodtest).
AssessifsimulationmodelinginformsCRCscreeningdelivery.
▶Aim
▶Methods
FecalTest
ModelValidity• AsperinternationalguidelinesbyISPOR-SMDM✶,20123.
✶InternationalSocietyforPharamaceconomics &OutcomesReporting-Soceity ofMedicalDecision-making
11.6
14.0
25.6
16.3
18.6
7.0
39.5
44.2
14.0
23.3
0 20 40 60 80
FaceValidation
InternalValidation
CrossValidation
ExternalValidation
PredictiveValidation
Proportionofarticles
Validationmetho
d
SIMULATIONMODELVALIDATION
Validate Mention
InformingCRCdelivery• 88%aimedtoaddressaspecifichealthpolicyandsystemsdecisioninCRCscreening.
• 11%reportanimpactonthatdecision.
• 25%involveddecision-makersinmodeldevelopment.
32.627.9
39.544.2
67.469.876.783.788.4
0 20 40 60 80
HealthequityUndesireableoutcome
PatientperspectiveStakeholderacceptance
FeasibilityCost-effectiveness
ResourcerequirementsDesireableoutcomePriorityofproblem
PROPORTIONOFARTICLESWITHCONTRIBUTINGEVIDENCE
FACTORSFORINFO
RMED
DECISIONS
CONTRIBUTIONTOINFORMINGHEALTHPOLICY&SYSTEMDECISIONS
1.TelfordJJ.Canadianguidelinesforcolorectalcancerscreening.CanJGastroenterol.2011;25(9):479-481.2.Katsaliaki K,Mustafee N.Applicationsofsimulationwithinthehealthcarecontext.JOper ResSoc.2011Aug1;62(8):1431–51
3.EddyDM,Hollingworth W,CaroJJ,Tsevat J,McDonaldKM,WongJB.ModelTransparencyandValidation:AReportoftheISPOR-SMDMModelingGoodResearchPracticesTaskForce-7.ValueinHealth.2012;15(6):843-850.doi:10.1016/j.jval.2012.04.012
4.Alonso-Coello P,Schünemann HJ,Moberg J,etal.GRADEEvidencetoDecision(EtD)frameworks:asystematicandtransparentapproachtomakingwellinformedhealthcarechoices.1:Introduction.BMJ.2016;353:i2016.doi:10.1136/bmj.i2016
GRADEEvidencetoDecision-makingFramework Criteria4Priorityofproblem
Weight ofpotentialbenefitsandharmsPatientperspectiveon valueStakeholderacceptance
FeasibilityCost-effectiveness
Resourcerequirements
Simulationmodelingisfrequentlyusedtoinformspecifichealthsystem&policydecisioninCRCscreening.
Ithasbeenusedtogenerateevidenceforabroadrangeoffactorscriticaltoinformeddecision-making.
Thereisneedforimprovedvalidationandreportingofoutcomestooptimizetheapplication&implementationofsimulationmodelinginhealthcare.
NEXTsteptodevelopguidelinesforstandardizedsimulationmodelingreportinginhealthcare.
ModelDescription• Developedusingpublisheddata(86%),registrydata(63%),andunpublisheddata(13%).
• Majorityincludedafigureofthemodel(67%)&describedmodellimitations(86%).
Cost-effectiveness
28%
Interventiontoincreasescreeninguptake15%
Comparescreeningmodalities
15%
Resourceutilization
13%
Specificpopulation
7%
Interval4%
Ageofinitiation
2%
Other11%
CancerPrevention
5%
SIMULATIONMODELAIM
Validation• 54%didnotreportanymodelvalidation.• Mostfrequentvalidationwascross-validation(44%).*
• Only7%conductedfacevalidation.✥
*comparingtooutputstosimilarmodels✥confirmingaccuracyofmodelwithexperts(ie clinicians,patients,policymakers).
ThankyoutoAlexandriaDaviesfromtheOttawaHospitalLibraryforherassistanceinconductingthesystematicdatabasesearch.ThisprojectwassupportedbytheNationalResearchandEducationCouncil,andbytheUniversityofTelfer SchoolofManagementStudentResearchGrant.
Improvessurvival&outcomes.Reducescancer.Cost-effective.
ModelinformingCRCdelivery• Reportedcontributiontohealthsystem/policydecision.
• Factorsforinformeddecisions4.
Colonoscopy