NOAHE Rounds II Session 9: Easy ways to improve cost-effectiveness analyses of cancer screening interventions and the role of an open-source pedagogical model in enhancing skills

Appraising the cost-effectiveness of cancer screening intervention relies heavily on simulation methods and does so in ways that differ from the assessment of pharmaceuticals. As a consequence, cost-effectiveness estimates of cancer screening interventions are highly contingent on the modelling choices made by analysts. While documentation of modelling best practice has improved, evidence from the published literature still demonstrates considerable variance in the quality of analyses. Fundamental errors in the choice of comparator strategies and the calculation of cost-effectiveness ratios are common. Other shortcomings of model methods are more subtle and have not been recognised within the screening CEA research community. Such shortcomings are striking given the sums spent annually on cancer screening and the potential health gains from well-optimised strategies.

This presentation will review some of the basic errors that are often made within cancer screening CEAs and provide guidance on how they can be easily avoided. The presentation will consider examples of how cervical cancer screening intensity has been poorly optimised. It will demonstrate the how the current Irish colorectal screening strategy is far below is its optimal intensity. The presentation will also briefly review why the literature to date on the cost-effectiveness of breast cancer screening does not provide a sound evidence base for current policy. The presentation will also consider how the current use of applied screening models can impede important aspects of research including, methods development, training of graduate students and analytical transparency. In order to address this, the presentation will demonstrate a simple modelling platform developed to enhance understanding of CEA simulation of cancer screening. This model is a microsimulation model coded in R and linked to an Excel-based user interface for the definition of parameters and the presentation of results.


James O'Mahony profile pictureDr. James O'Mahony is a health economist with prior training in economics. His primary area of research is in the cost-effectiveness of cancer screening. In particular, he works with the CERVIVA consortium on the prevention of cervical cancer and other HPV-related diseases. This work involves microsimulation modelling of screening interventions. James has a research interest in the mismatch between CEA models the policy questions facing decision makers. His work in this area reflects a broader research interest in the methods of cost-effectiveness analysis in general. He is interested in the choice of modelling methods and how this influences the metrics purported to inform policy choices. He has worked on the cost-effectiveness threshold and decision maker's adherence to it. He has also published on discounting and the handling of time in cost-effectiveness analyses.

Event Details

Please note updated date and time!

Date: Thursday, June 13, 2019
Time: 10:00 am MT
Location: University of Alberta, Venue TBD


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