Economic evaluation and modelling methods in the context of bottlenecks in the diagnosis and treatment of cancer
Project theme: Methods development
This is a joint project with the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis. Over recent years there has been an increased failure to meet waiting time targets with regards to the identification and treatment of cancers . This situation has been further exacerbated by the COVID-19 pandemic [1–3]. Delayed identification and treatment of cancers can lead to adverse health outcomes and deaths [4,5]. Policies and interventions are needed to help reduce cancer waiting times to improve population health. These could include, for example, alternative stratification approaches to prioritize certain groups, technological solutions (e.g. use of triage tests such as the cytosponge for suspected Barrett’ oesophagus  or faecal calprotectin for suspect colorectal cancer ), increased staffing or task shifting.
To help inform decision making regarding the choice of policies and interventions, evidence on the resource requirements, costs, benefits and impacts on population health of the alternative approaches is required. Economic evaluation and decision analysis provide a framework for helping to inform the decisions by assessing the population health impact of the policies under consideration [8–10]. However, standard approaches to modelling, economic evaluation and decision analysis may not be appropriate for the evaluation of the policies and interventions being considered to help reduce cancer waiting times . There may be multiple constraints on care (financial and non-financial) and the financial costs of particular staff (e.g. endoscopists) may not accurately reflect their value if they are particularly constrained [11–13]. Further, the interdependence of the different components of the system means they cannot be considered in isolation or the options under consideration are complex, can be used in combination and potentially evolve over time (e.g. a decision to increase staff may take several years to implement) [10,12,13]. As a result, novel approaches to economic evaluation bringing in insights from other fields, such as operational research, should be considered so that evidence on the impacts of the options available on population health can be generated [14–17].
This project will aim to develop approaches to the economic evaluation of policies and interventions which reduce waiting times in the diagnosis and/or treatment of cancer and apply them to a case study in one type of cancer to inform policy by:
i) Developing a case study in one area of cancer and evaluate potential policy options to alleviate the waiting times.
ii) Demonstrating how the methods developed can be applied to tackle waiting times for other cancers and other diseases.
Simon Walker (EEPRU, York), Mark Sculpher (EEPRU, York), Marta Soares (EEPRU, York), Willie Hamilton (CASED PRU Exeter), Fiona Walter, (CASED PRU, QMUL), Daniel Vulkan, (CASED PRU, QMUL)