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