Journal of Simulation

, Volume 4, Issue 1, pp 14–23

A review of discrete event simulation in National Coordinating Centre for Health Technology Assessment-funded work and a case study exploring the cost-effectiveness of testing for thrombophilia in patients presenting with an initial idiopathic venous thromboembolism

  • M D Stevenson
  • E L Simpson
  • A C Rawdin
  • D E Papaioannou
Article

DOI: 10.1057/jos.2009.12

Cite this article as:
Stevenson, M., Simpson, E., Rawdin, A. et al. J Simulation (2010) 4: 14. doi:10.1057/jos.2009.12

Abstract

A review of modelling work funded by the National Coordinating Centre for Health Technology Assessment (NCCHTA) was undertaken to quantify the use of discrete event simulation (DES) techniques in health economics. A case study, funded by the NCCHTA, estimating the cost-effectiveness of thrombophilia testing is presented. Thrombophilia may increase the risk of venous thromboembolism (VTE) which can be fatal; however, the preventative treatment, warfarin, is associated with an increased risk of haemorrhage, which is also potentially fatal. A DES model, populated from literature reviews and incorporating VTE events, haemorrhages and death was constructed. The most cost-effective duration of warfarin treatment (‘standard treatment’ of 3 or 6 months, 10 years, 20 years or lifelong) was estimated for patients with initial idiopathic VTE, sub-divided into age, gender, VTE type and known thrombophilia type groups. The primary goal was to ascertain, for each sub-group, whether the cost of thrombophilia testing for all patients, given subsequent tailoring of warfarin duration, would be cost-effective. Thrombophilia testing was estimated to be cost-effective in most sub-groups; however these results are subject to large uncertainty. Primary research is required before a definitive conclusion can be reached.

Keywords

simulationhealth servicedecision analysiscost benefit

Copyright information

© Operational Research Society 2010

Authors and Affiliations

  • M D Stevenson
    • 1
  • E L Simpson
    • 1
  • A C Rawdin
    • 1
  • D E Papaioannou
    • 1
  1. 1.University of SheffieldSheffieldUK