1. 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)

2. 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.
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© The University of Sheffield

3. 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.
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© The University of Sheffield

4. 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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© The University of Sheffield

5. 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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© The University of Sheffield

6. 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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© The University of Sheffield

7. Conceptual model
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8. QUOROM flow diagram
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9. Availability of economic evidence
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10. Availability of economic evidence
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11. Availability of economic evidence
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12. 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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© The University of Sheffield

13. 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.
16/01/2019
© The University of Sheffield

14. 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.
16/01/2019
© The University of Sheffield

15. 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.
16/01/2019
© The University of Sheffield

16. Pilot Service-Level Model - Scope
Population
Individuals with/without bowel cancer who consume bowel cancer resources
Interventions
Comparator (baseline)
The current bowel cancer service in England
Outcomes
Cost per LYG, cost per QALY gained
Screening
Public awareness campaigns
Improved referral criteria
Increased use of endoscopy
Increased use of stenting
Improved surgery/pathology
Enhanced recovery programmes
Adjuvant treatments
Follow-up regimens
Treatments for mets
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© The University of Sheffield

17. Model structure
Soft elicitation of model structure via leading experts
DES model using SIMUL8
Populated using best available evidence
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18. Cost-effectiveness results
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19. 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.
16/01/2019
© The University of Sheffield