BackgroundA trade-off exists between building confidence in health-economic (HE) decision models and the use of scarce resources. We aimed to create a practical tool providing model users with a structured view into the validation status of HE decision models, to address this trade-off.MethodsA Delphi panel was organized, and was completed by a workshop during an international conference. The proposed tool was constructed iteratively based on comments from, and the discussion amongst, panellists. During the Delphi process, comments were solicited on the importance and feasibility of possible validation techniques for modellers, their relevance for decision makers, and the overall structure and formulation in the tool.ResultsThe panel consisted of 47 experts in HE modelling and HE decision making from various professional and international backgrounds. In addition, 50 discussants actively engaged in the discussion at the conference workshop and returned 19 questionnaires with additional comments. The final version consists of 13 items covering all relevant aspects of HE decision models: the conceptual model, the input data, the implemented software program, and the model outcomes.ConclusionsAssessment of the Validation Status of Health-Economic decision models (AdViSHE) is a validation-assessment tool in which model developers report in a systematic way both on validation efforts performed and on their outcomes. Subsequently, model users can establish whether confidence in the model is justified or whether additional validation efforts should be undertaken. In this way, AdViSHE enhances transparency of the validation status of HE models and supports efficient model validation.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-015-0327-2) contains supplementary material, which is available to authorized users.

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[1] Ice core measurements have revealed a highly asymmetric cycle in Antarctic temperature and atmospheric CO 2 over the last 800 kyr. Both CO 2 and temperature decrease over 100 kyr going into a glacial period and then rise steeply over less than 10 kyr at the end of a glacial period. There does not yet exist wide agreement about the causes of this cycle or about the origin of its shape. Here we explore the possibility that an ecologically driven oscillator plays a role in the dynamics. A conceptual model describing the interaction between calcifying plankton and ocean alkalinity shows interesting features: (i) It generates an oscillation in atmospheric CO 2 with the characteristic asymmetric shape observed in the ice core record, (ii) the system can transform a sinusoidal Milankovitch forcing into a sawtooth-shaped output, and (iii) there are spikes of enhanced calcifier productivity at the glacial-interglacial transitions, consistent with several sedimentary records. This suggests that ecological processes might play an active role in the observed glacial-interglacial cycles.

Socio-Ecological Systems (SESs) are the systems in which our everyday lives are embedded, so understanding them is important. The complex properties of such systems make modelling an indispensable tool for their description and analysis. Human actors play a pivotal role in SESs, but their interactions with each other and their environment are often underrepresented in SES modelling. We argue that more attention should be given to social aspects in models of SESs, but this entails additional kinds of complexity. Modelling choices need to be as transparent as possible, and to be based on analysis of the purposes and limitations of modelling. We recommend thinking in terms of modelling projects rather than single models. Such a project may involve multiple models adopting di↵erent modelling methods. We argue that agent-based models (ABMs) are an essential tool in an SES modelling project, but their expressivity, which is their major advantage, also produces problems with model transparency and validation. We propose the use of formal ontologies to make the structure and meaning of models as explicit as possible, facilitating model design, implementation, assessment, comparison and extension.

Evaluations of healthcare interventions, e.g. new drugs or other new treatment strategies, commonly include a cost-effectiveness analysis (CEA) that is based on the application of health economic (HE) models. As end users, patients are important stakeholders regarding the outcomes of CEAs, yet their knowledge of HE model development and application, or their involvement therein, is absent. This paper considers possible benefits and risks of patient involvement in HE model development and application for modellers and patients. An exploratory review of the literature has been performed on stakeholder-involved modelling in various disciplines. In addition, Dutch patient experts have been interviewed about their experience in, and opinion about, the application of HE models. Patients have little to no knowledge of HE models and are seldom involved in HE model development and application. Benefits of becoming involved would include a greater understanding and possible acceptance by patients of HE model application, improved model validation, and a more direct infusion of patient expertise. Risks would include patient bias and increased costs of modelling. Patient involvement in HE modelling seems to carry several benefits as well as risks. We claim that the benefits may outweigh the risks and that patients should become involved.

a b s t r a c tModelers involved in environmental policy assessments are commonly confronted with the lack of uptake of model output by policy actors. Actors have different expectations of models, condensed into three quality criteria: credibility, salience, and legitimacy. The fulfilment of quality criteria is also dynamic as expectations vary, change, and possibly counteract each other. We present a checklist for modelers involved in model-based assessments that is aimed at the identification and monitoring of issues, limitations and trade-offs regarding model quality criteria. It draws upon the literature of integrated assessments as well as case study analysis of environmental policy assessments for the Dutch government, based on expert interviews and embedded experience. The checklist is intended to be consulted during assessments; its application may result in greater awareness among modelers involved in assessments regarding model quality criteria, and may positively affect the uptake of model-based knowledge from environmental policy assessments by policy actors.

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Stoichiometric constraints play a role in the dynamics of natural populations but are not explicitly considered in most mathematical models. Recent theoretical works suggest that these constraints can have a significant impact and should not be neglected. However, it is not yet resolved how stoichiometry should be integrated in population dynamical models, as different modeling approaches are found to yield qualitatively different results. Here we investigate a unifying framework that reveals the differences and commonalities between previously proposed models for producer-grazer systems. Our analysis reveals that stoichiometric constraints affect the dynamics mainly by increasing the intraspecific competition between producers and by introducing a variable biomass conversion efficiency. The intraspecific competition has a strongly stabilizing effect on the system, whereas the variable conversion efficiency resulting from a variable food quality is the main determinant for the nature of the instability once destabilization occurs. Only if the food quality is high can an oscillatory instability, as in the classical paradox of enrichment, occur. While the generalized model reveals that the generic insights remain valid in a large class of models, we show that other details such as the specific sequence of bifurcations encountered in enrichment scenarios can depend sensitively on assumptions made in modeling stoichiometric constraints.