Use of Simulation Modeling to Inform Decision Making for Health Care Systems and Policy in Colorectal Cancer Screening: Protocol for a Systematic Review
Authors: Smith Heather , Varshoei Peyman , Boushey Robin , Kuziemsky Craig 
Published: November 2019

Background
Simulation modeling has frequently been used to assess interventions in complex aspects of health care, such as colorectal cancer (CRC) screening, where clinical trials are not feasible. Simulation models provide estimates of outcomes, unintended consequences, and costs of an intervention; thus offering an invaluable decision aid for policy makers and health care leaders. However, the contribution that simulation models have made to policy and health system decisions is unknown.

Objective
This study aims to assess if simulation modeling has supported evidence-informed decision making in CRC screening.

Methods
A preliminary literature search and pilot screening of 100 references were conducted by three independent reviewers to define and refine the inclusion criteria of this systematic review. Using the developed inclusion criteria, a search of the academic and gray literature published between January 1, 2008, and March 1, 2019, will be conducted to identify studies that developed a simulation model focusing on the delivery of CRC screening of average-risk individuals. The three independent reviewers will assess the validation process and the extent to which the study contributed evidence toward informed decision making (both reported and potential). Validation will be assessed based on adherence to the best practice recommendations described by the International Society for Pharmacoeconomics and Outcomes Research-Society for Medical Decision Making (ISPOR-SMDM). Criteria for potential contribution to decision making will be defined as outlined in the internationally recognized Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision (GRADE EtD) framework. These criteria outline information that the health system and policy decision makers should consider when making an evidence-informed decision including an intervention’s resource utilization, cost-effectiveness, impact on health equity, and feasibility. Subgroup analysis of articles based on their GRADE EtD criteria will be conducted to identify methods associated with decision support capacity (ie, participatory, quantitative, or mixed methods).

Results
A database search of the literature yielded 484 references to screen for inclusion in the systematic review. We anticipate that this systematic review will provide an insight into the contribution of simulation modeling methods to informed decision making in CRC screening delivery and discuss methods that may be associated with a stronger impact on decision making. The project was funded in May 2019. Data collection took place from January 2008 to March 2019. Data analysis was completed in November 2019, and are expected to be published in spring 2020.

Conclusions
Our findings will help guide researchers and health care leaders to mobilize the potential for simulation modeling to inform evidence-informed decisions in CRC screening delivery. The methods of this study may also be replicated to assess the utility of simulation modeling in other areas of complex health care decision making.

International Registered Report Identifier (IRRID)
DERR1-10.2196/16103

Trial Registration
PROSPERO no. 130823; https://www.crd.york.ac.uk/PROSPERO