Building Better Models

T landmark issue of Medical Decision Making summarizes important deliberations about best practices for simulation modeling. This body of work represents the third major set of recommendations for modeling best practices in the past 2 decades. The current project, sponsored jointly by the International Society for Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making, builds on and extends prior efforts to set standards for the conduct of modeling. These new articles provide modelers with guidance on building more useful models and consumers with benchmarks to judge the quality of the models. These thoughtful guidelines should strengthen the integrity of the model development process and encourage broader use of models in decision making. Modeling has long been embraced by the medical decision-making community and other researchers concerned with evidence-based practices and outcomes. In 2009, simulation modeling was recommended by the Institute of Medicine as a method to quantify the net impact of medical interventions. More recently, the Patient-Centered Outcomes Research Institute has been charged with using a variety of methods, including modeling, to evaluate the comparative effectiveness of medical interventions (www.pcori.org). In addition, more complex and biologically accurate models are now possible because of computing and information technology advances. Until recently, however, models affected few coverage and policy decisions in the United States. Models were used in setting American Cancer Society cervical cancer screening guidelines in the 1980s. In the late 1980s, the US Congress’ Office of Technology Assessment (OTA) commissioned models to evaluate screening for cervical and breast cancer under the Medicare program. The results were influential in the decisions to extend Medicare benefits to include Pap smears and mammography between 1988 and 1990. Unfortunately, the OTA was de-funded in 1995. Cancer modeling gained renewed support in 1999, when the Institute of Medicine released a report on the quality of care and called for greater inclusion of cancer outcomes research at the National Cancer Institute (NCI). Meanwhile, outside of the United States, modeling has been and continues to be used to guide policy on a routine basis. In the United Kingdom, for example, cost-effectiveness results from models are required for health care coverage decisions. Modeling of cancer interventions was advanced in the late 1990s with the funding of NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET). Over the past 15 years, CISNET has gained traction in advancing the use of modeling to inform policy and clinical practice. Several aspects of the CISNET modeling approach have contributed to its success, including use of best modeling practices, similar to those outlined in this issue; deployment of more than one model to address a specific research question; development of a template for the description of the models; and commitment to transparency and collaboration. For example, by having Building Better Models: If We Build Them, Will Policy Makers Use Them? Toward Integrating Modeling into Health Care Decisions