title: Whole disease modeling to inform resource allocation decisions in cancer: a methodological framework.
abstract: OBJECTIVE
  This article presents a methodological framework for developing health economic models of whole systems of disease and treatment pathways to inform decisions concerning resource allocation-an approach referred to as "Whole Disease Modeling." This system-level approach can provide a consistent mathematical infrastructure for the economic evaluation of virtually any intervention across a disease pathway.
  
  
  METHODS
  The framework has been developed for cancer but is broadly generalizable to other diseases. It has been informed by pilot work, a systematic review of economic analyses, a qualitative examination of model development processes, and other literature from the fields of operational research, statistics, and health economics.
  
  
  RESULTS
  The framework is built on three principles: 1) the model boundary and breadth should capture all relevant aspects of the disease and its treatment-from preclinical disease through to death, 2) the model should be developed such that the decision node is conceptually transferable across the model, and 3) the costs and consequences of service elements should be structurally related. A generalized process for developing Whole Disease Models is presented.
  
  
  CONCLUSIONS
  Although this approach involves a nontrivial investment of time and resource, its value may be realized when 1) multiple options for service change require economic analysis at a single time point, 2) a disease service changes rapidly and the model can be reused, 3) current services within a pathway have not been subjected to economic analysis, 4) upstream events are expected to have important downstream effects, or 5) simple cost-utility decision rules fail to reflect the complexity of the decision-makers' objectives.
authors.affiliation: Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. p.tappenden@sheffield.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Tappenden
authors.forename: Jim
authors.initials: J
authors.lastname: Chilcott
authors.forename: Alan
authors.initials: A
authors.lastname: Brennan
authors.forename: Hazel
authors.initials: H
authors.lastname: Squires
authors.forename: Matthew
authors.initials: M
authors.lastname: Stevenson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D015276:Health Care Rationing / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D018803:Models, Economic; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents