Using Whole Disease Models to Inform Resource Allocation Decisions

Abstract

Health economic models are currently used to inform policy decisions concerning whether health technologies represent value for money.The conventional approach to health economic modelling usually focuses on a single decision at an isolated point of a broader clinical pathway, forexample: "Is Herceptin plus chemotherapy cost-effective in comparison to chemotherapy alone for the treatment of HER2 positive breast cancer?"However, the cost-effectiveness of technologies may be dependent on other upstream and downstream components of the service; these are rarely captured consistently between models and in many cases, economic analyses of whole portions of the pathway are entirely absent. This study concerns the development, implementation and evaluation of a methodological framework for Whole Disease Modelling. The distinguishing characteristics of Whole Disease Modelling that set it apart from conventional approaches to cost-effectiveness analysis are the scope of the analysis and the structural ability of the model to consider the knock-on impacts of health technologies across the entire pathway. In cancer, this involves modelling "the bigger picture", that is, the entire disease and treatment pathway from pre-clinical disease through to diagnosis and referral, adjuvant treatment, follow-up, potential local or metastatic recurrence, palliative treatment, end-of-life care and eventual death. This seminar will outline the general principles of the approach via a case study application, and will highlight its benefits in terms of increased consistency between evaluations, the ability to consider options across the whole care pathway together or in isolation within the same model framework, and the increased flexibility in the adopted resource allocation decision rules.