Transcript presentation

Modelling the “bigger picture”
Using Service-Level Modelling to support
consistent resource allocation decisions
across whole disease areas
HTAi 2008
Paul Tappenden, Jim Chilcott, Alan Brennan, Hazel Pilgrim
School of Health and Related Research (ScHARR)
Funding and disclaimer
• This work forms part of an ongoing study funded
through a Department of Health Researcher
Development Award (RDA) fellowship.
• The views expressed here are those of the authors
and do not necessarily reflect those of the
Department of Health.
17/07/2016 © The University of Sheffield
Research aims
• To develop, implement and evaluate a
methodological framework for modelling whole
diseases to inform decisions concerning balancing
investments across entire care pathways.
– Approach consistent with the principles of economic
evaluation and opportunity cost.
– Develop health economic models which are more useful for
decision-makers.
– “Service-Level Modelling”
– Piloted in bowel cancer, transferable to any disease area.
17/07/2016 © The University of Sheffield
The “typical” HTA model
• Theoretically correct
approach to maximising
health gains.
• Threshold determined
by CE of last technology
purchased.
• HTA models involve
forward projection from
single decision node.
• Comparison against
threshold/range.
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Economic evaluation
• Non-economic economic evaluations
• Development of complex models
– We build increasingly more sophisticated models…
– …and then we reduce the whole thing down to an ICER...
– …and then compare it against an arbitrary threshold.
• The cost-effectiveness of one technology is dependent
on other decisions made throughout the pathway.
• Taking a systems view may address these problems.
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Systematic review
• What evidence is currently available to policy-makers?
• Systematic review of all UK economic evaluations of
technologies for the prevention, detection, diagnosis,
treatment and follow-up of colorectal cancer.
• Detailed systematic searches of 10 electronic databases
(Medline, Premedline, EMBASE, Cinahl, Cochrane,
Econlit etc) plus conference proceedings (ASCO &
ESMO).
• Included studies mapped against conceptual model of
current UK bowel cancer service to identify any gaps.
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Conceptual model
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QUOROM flow diagram
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Availability of economic evidence
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Availability of economic evidence
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Availability of economic evidence
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Preliminary review findings
• Strong economic evidence base for screening (13); surgery
(9); adjuvant chemotherapy for colon cancer (4); follow-up (3);
and palliative chemotherapy (15).
• Limited evidence for diagnosis (3) and liver resection (1).
• No economic evidence relating to RT/CRT; FAP/HNPCC;
increased-risk surveillance; and end-of-life care.
• Heterogeneity in terms of:
– scope
– natural history
– detail/inclusion of downstream service provision and its costs & effects
• Very limited evaluation of how services should be provided.
• Very difficult to see how this could inform consistent decisions.
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Service-Level Models
• Usefulness of models is in part determined by the scope of
the decision it is intended to inform.
• Single isolated point versus whole pathway model.
• Economic analysis of any technology/configuration of
services.
17/07/2016 © The University of Sheffield
Service-Level Models
• Usefulness of models is in part determined by the scope of
the decision it is intended to inform.
• Single isolated point versus whole pathway model.
• Economic analysis of any technology/configuration of
services.
17/07/2016 © The University of Sheffield
Service-Level Models
• Usefulness of models is in part determined by the scope of
the decision it is intended to inform.
• Single isolated point versus whole pathway model.
• Economic analysis of any technology/configuration of
services.
17/07/2016 © The University of Sheffield
Pilot Service-Level Model - Scope
• Population
– Individuals with/without bowel cancer who consume
bowel cancer resources
• Interventions
– Screening
– Improved referral criteria
– Increased use of stenting
– Enhanced recovery programmes
– Follow-up regimens
– Public awareness campaigns
– Increased use of endoscopy
– Improved surgery/pathology
– Adjuvant treatments
– Treatments for mets
• Comparator (baseline)
– The current bowel cancer service in England
• Outcomes
– Cost per LYG, cost per QALY gained
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Model structure
• Soft elicitation of model structure via leading experts
• DES model using SIMUL8
• Populated using best available evidence
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Cost-effectiveness results
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Future direction and challenges
• Some future challenges
– Problem-structuring.
– Identifying decision-making needs and how SLM may address these.
– Identifying, selecting and synthesising evidence across disease areas.
• Service-Level Modelling
– may provide a balanced assessment of whole service configurations,
accounting for knock-on impacts and opportunity cost.
– may help foster consistent investment decisions.
– may help draw out important gaps in the current evidence base.
– is feasible.
17/07/2016 © The University of Sheffield