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Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening

Glover, Matthew J., Jones, Edmund, Masconi, Katya L., Sweeting, Michael J., Thompson, Simon G., Powell, Janet T., Ulug, Pinar and Bown, Matthew J. (2018) Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening Medical Decision Making, 38 (4). pp. 439-451.

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Markov models are often used to evaluate the cost-effectiveness of new healthcare interventions but they are sometimes not flexible enough to allow accurate modeling or investigation of alternative scenarios and policies. A Markov model previously demonstrated that a one-off invitation to screening for abdominal aortic aneurysm (AAA) for men aged 65 y in the UK and subsequent follow-up of identified AAAs was likely to be highly cost-effective at thresholds commonly adopted in the UK (£20,000 to £30,000 per quality adjusted life-year). However, new evidence has emerged and the decision problem has evolved to include exploration of the circumstances under which AAA screening may be cost-effective, which the Markov model is not easily able to address. A new model to handle this more complex decision problem was needed, and the case of AAA screening thus provides an illustration of the relative merits of Markov models and discrete event simulation (DES) models. An individual-level DES model was built using the R programming language to reflect possible events and pathways of individuals invited to screening v. those not invited. The model was validated against key events and cost-effectiveness, as observed in a large, randomized trial. Different screening protocol scenarios were investigated to demonstrate the flexibility of the DES. The case of AAA screening highlights the benefits of DES, particularly in the context of screening studies.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Glover, Matthew
Jones, Edmund
Masconi, Katya L.
Sweeting, Michael J.
Thompson, Simon G.
Powell, Janet T.
Ulug, Pinar
Bown, Matthew J.
Date : 2 April 2018
Funders : National Institute for Health Research (NIHR)
DOI : 10.1177/0272989X17753380
OA Location :
Grant Title : Health Technology Appraisal (HTA) programme
Copyright Disclaimer : © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
Uncontrolled Keywords : Abdominal aortic aneurysm; Decision analytic model; Discrete event simulation; Markov model; Screening
Depositing User : Clive Harris
Date Deposited : 29 Apr 2020 14:34
Last Modified : 29 Apr 2020 14:34

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