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Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening.

Matthew J Glover1, Edmund Jones2, Katya L Masconi2

  • 1Health Economics Research Group, Brunel University London, Uxbridge, Middlesex, UK.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|November 1, 2019
PubMed
Summary

Discrete event simulation (DES) models offer greater flexibility than Markov models for evaluating healthcare interventions like abdominal aortic aneurysm (AAA) screening. This study demonstrates DES’s advantages for complex screening scenarios.

Keywords:
Markov modelabdominal aortic aneurysmdecision analytic modeldiscrete event simulationscreening

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Area of Science:

  • Health economics
  • Medical decision modeling
  • Public health screening programs

Background:

  • Markov models are common for cost-effectiveness analysis but lack flexibility for complex scenarios.
  • Previous Markov models suggested abdominal aortic aneurysm (AAA) screening is cost-effective in the UK.
  • Evolving evidence necessitates more adaptable models for exploring AAA screening cost-effectiveness under various conditions.

Purpose of the Study:

  • To address the limitations of Markov models in evaluating complex healthcare interventions.
  • To illustrate the comparative advantages of discrete event simulation (DES) over Markov models.
  • To explore the cost-effectiveness of abdominal aortic aneurysm (AAA) screening under diverse scenarios.

Main Methods:

  • An individual-level discrete event simulation (DES) model was developed using the R programming language.
  • The DES model simulated pathways for individuals invited to screening versus those not invited.
  • Model validation was performed against key events and cost-effectiveness data from a large randomized trial.

Main Results:

  • The DES model demonstrated flexibility in investigating various screening protocol scenarios.
  • The study highlights the benefits of DES for analyzing complex screening interventions.
  • The findings support the utility of DES for nuanced health economic evaluations.

Conclusions:

  • Discrete event simulation (DES) provides a more flexible and adaptable approach for health economic evaluations compared to traditional Markov models.
  • The developed DES model effectively addressed the complexities of abdominal aortic aneurysm (AAA) screening.
  • DES is particularly beneficial for evaluating screening programs and exploring policy alternatives.