The Role of Microsimulation Modeling in Evaluating the Outcomes and Effect of Screening

Microsimulation modeling was introduced to the social sciences in the 1950s, but did not play any significant role in health care until the 1980s. The rapid growth and plunging cost of computing power in that era supported a sustained penetration of simulation modeling into health services research and policy analysis. In this chapter we provide an overview of how modeling of breast cancer screening is done and review how microsimulations have been used to interpret and understand the results of clinical trials and observational studies, to project results of modifying screening programs and to estimate cost-effectiveness. The limitations of modeling as a method of gaining reliable information are reviewed; the most important potential sources of uncertainty, and how they are dealt with, are discussed. New applications of microsimulation in the field of breast cancer control are mentioned as possible future directions.