Discrete event simulation of whole care pathways to estimate cost-effectiveness in clinical guidelines

For pragmatic reasons, cost-effectiveness analyses performed for NICE Clinical Guidelines use a piecemeal approach, evaluating only selected aspects of diagnosis, treatment or care. A Whole Pathway approach, considering diagnosis-to-death, may provide more realistic estimates of costs and health outcomes, taking account of the healthcare context and individual risk factors, history and choices for patients with long-term conditions. A patient-level DES model using the characteristics of 12,766 real patients was created to reflect the NICE guideline for Atrial Fibrillation. Of eight topics suggested for inclusion in an update of the guideline, the model was capable of fully answering four topics, and partially answering two topics. The remaining topics were beyond the scope of the model. The model was used by NICE in their recent update of the Atrial Fibrillation Clinical Guidelines.