Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening
Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening
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DOI：
10.1177/0272989x17753380
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发表时间：
2018-05-01
影响因子：
3.6
通讯作者：
Thompson, Simon G.
中科院分区：
文献类型：
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作者：
Glover, Matthew J.;Jones, Edmund;Thompson, Simon G.
马尔可夫模型通常用于评估新的医疗保健干预措施的成本效益，但它们有时不够灵活，无法准确建模或调查替代方案和政策。先前的马尔可夫模型表明，在英国，一次性邀请65岁男性进行腹主动脉瘤（AAA）筛查，随后对确定的AAA进行随访，在英国通常采用的阈值（每质量调整生命年20，000磅至30，000磅）下可能具有高度的成本效益。然而，新的证据已经出现，决策问题已经发展到包括探索AAA筛查可能具有成本效益的情况下，马尔可夫模型不容易解决。需要一个新的模型来处理这个更复杂的决策问题，因此，AAA筛选的情况下提供了一个例子，马尔可夫模型和离散事件模拟（DES）模型的相对优点。使用R编程语言构建了一个个体水平的DES模型，以反映被邀请进行筛选的个体与未被邀请的个体之间可能的事件和途径。根据一项大型随机试验中观察到的关键事件和成本效益，对该模型进行了验证。研究了不同的筛选方案方案，以证明DES的灵活性。AAA筛查的案例突出了DES的益处，特别是在筛查研究的背景下。
Markov models are often used to evaluate the cost-effectiveness of new healthcare interventions but they are sometimes not flexible enough to allow accurate modeling or investigation of alternative scenarios and policies. A Markov model previously demonstrated that a one-off invitation to screening for abdominal aortic aneurysm (AAA) for men aged 65 y in the UK and subsequent follow-up of identified AAAs was likely to be highly cost-effective at thresholds commonly adopted in the UK (20,000 pound to 30,000 pound per quality adjusted life-year). However, new evidence has emerged and the decision problem has evolved to include exploration of the circumstances under which AAA screening may be cost-effective, which the Markov model is not easily able to address. A new model to handle this more complex decision problem was needed, and the case of AAA screening thus provides an illustration of the relative merits of Markov models and discrete event simulation (DES) models. An individual-level DES model was built using the R programming language to reflect possible events and pathways of individuals invited to screening v. those not invited. The model was validated against key events and cost-effectiveness, as observed in a large, randomized trial. Different screening protocol scenarios were investigated to demonstrate the flexibility of the DES. The case of AAA screening highlights the benefits of DES, particularly in the context of screening studies.