Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada.
Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Am Med Inform Assoc. 2020 Jun 1;27(6):908-916. doi: 10.1093/jamia/ocaa022.
This study sought to assess the impact and validity of simulation modeling in informing decision making in a complex area of healthcare delivery: colorectal cancer (CRC) screening.
We searched 10 electronic databases for English-language articles published between January 1, 2008, and March 1, 2019, that described the development of a simulation model with a focus on average-risk CRC screening delivery. Included articles were reviewed for evidence that the model was validated, and provided real or potential contribution to informed decision making using the GRADE EtD (Grading of Recommendations Assessment, Development, and Evaluation Evidence to Decision) framework.
A total of 43 studies met criteria. The majority used Markov modeling (n = 31 [72%]) and sought to determine cost-effectiveness, compare screening modalities, or assess effectiveness of screening. No study reported full model validation and only (58%) reported conducting any validation. Majority of models were developed to address a specific health systems or policy question; few articles report the model's impact on this decision (n = 39 [91%] vs. n = 5 [12%]). Overall, models provided evidence relevant to every element important to decision makers as outlined in the GRADE EtD framework.
Simulation modeling contributes evidence that is considered valuable to decision making in CRC screening delivery, particularly in assessing cost-effectiveness and comparing screening modalities. However, the actual impact on decisions and validity of models is lacking in the literature. Greater validity testing, impact assessment, and standardized reporting of both is needed to understand and demonstrate the reliability and utility of simulation modeling.
本研究旨在评估模拟建模在为医疗保健领域的一个复杂领域（即结直肠癌（CRC）筛查）提供决策信息方面的影响和有效性。
我们检索了 10 个英文数据库，以获取 2008 年 1 月 1 日至 2019 年 3 月 1 日期间发表的侧重于平均风险 CRC 筛查交付的模拟模型开发的文章。纳入的文章经过了审查，以证明模型是否经过验证，并使用 GRADE EtD（推荐评估、制定和评估框架）框架提供了对知情决策的真实或潜在贡献。
共有 43 项研究符合标准。大多数研究使用了马尔可夫模型（n = 31 [72%]），旨在确定成本效益、比较筛查方式或评估筛查效果。没有研究报告完整的模型验证，只有 58%的研究报告进行了任何验证。大多数模型是为解决特定的卫生系统或政策问题而开发的；很少有文章报告模型对这一决策的影响（n = 39 [91%] vs. n = 5 [12%]）。总体而言，模型提供的证据与 GRADE EtD 框架中概述的决策者重要的每一个要素都相关。
模拟建模为 CRC 筛查交付中的决策提供了有价值的证据，特别是在评估成本效益和比较筛查方式方面。然而，文献中缺乏对模型实际影响和有效性的研究。需要进行更多的有效性测试、影响评估和对两者的标准化报告，以了解和展示模拟建模的可靠性和实用性。
