The use of cancer service simulation modelling to inform clinical policy and resource allocation decisions

Funding: Department of Health Personal Award Scheme
Award Holder: Mr Paul Tappenden
Dates: 2007-2010


To develop, implement and evaluate a methodological framework for modelling whole disease areas to inform resource allocation decisions.


Health economic models are currently used to inform policy decisions concerning whether health technologies represent value for money for the NHS. Current approaches to health economic evaluation adopt a decision-analytic framework, which focuses on a single decision at an isolated point of a broader clinical pathway, for example: "Is Herceptin plus chemotherapy cost-effective in comparison to chemotherapy alone for the treatment of HER2 positive breast cancer?" The development of methods for constructing consistent models of whole disease areas helps to foster more consistent decision-making.

This study aims to develop, implement and evaluate a methodological framework for simulating whole disease areas (referred to as Service-Level Modelling). The distinguishing characteristics of the Service-Level Modelling approach that set it apart from conventional approaches to cost-effectiveness analysis are the scope of the analysis (the boundary around the model) and the structural ability of the model to consider the knock-on impacts of health technologies on other parts of the service. The Service-Level Modelling framework will involve 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 approach has been piloted in bowel cancer; however, methodological development is required.

Diagram showing modelling framework

The study will be undertaken within two broad phases of research:

Phase 1

The aim of this phase of research is to reflect on the pilot application of the whole disease modelling methodology and to identify methodological gaps. This will involve (1) examining existing existing economic evidence in bowel cancer; (2) critical examination of the pilot bowel cancer service model; (3) in-depth interviews with NHS decision-makers to explore their decision-making needs; and (4) development of a methodological framework for modelling whole disease areas.

Phase 2

The aim of this phase is to apply the methodological framework within a second cancer area and to evaluate it in terms of its perceived value in supporting decision-making.

Further information

The pilot application of this approach has been accepted for publication in the Journal of the Operational Research Society: Pilgrim H, Tappenden P, Chilcott JB, Bending M, Trueman P. The costs and benefits of bowel cancer service developments using discrete event simulation. Journal of the Operational Research Society [e-print available online ahead of publication].

A presentation on the background of the project was given at the Health Technology Assessment International (HTAi) conference in Montreal 2008 (8th July 2008).

For further information on this project please contact the award holder, Paul Tappenden (