ABSTRACT
In order to illustrate the implementation of a discrete event simulation (DES) for a real health technology assessment (HTA), a case study is presented. This case study describes the development and analysis of a DES of alternative options for the use of mammography to monitor women following the diagnosis and treatment of early breast cancer (Bessen and Karnon 2014). The aim of this monitoring or surveillance is to detect recurrent localized cancer at an early stage and, thus, enable treatment of the recurrent cancer with the aim of preventing further disease progression. Currently, it is recommended that most women undergo annual mammography for the detection of recurrent disease. The rationale for the modeling study was that women with early breast cancer have a wide range of prognoses (risk of recurrence), and that the one-size-fits-all surveillance strategy may be over-screening women at low risk of recurrence. The aim of this study was to define cost-effective surveillance strategies for women with early breast cancer, at various levels of recurrence risk.
