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Model Submission / Intake Form (Woocommerce + SCF) (Product)

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Model Basic Information
Model Detail
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Contact Information

Fill out the submission form on this website.
All required fields are marked with an *
Person 1 will be the primary contact.
Other authors or contributors can be added later.

Person 1 *

First Name

Last Name

Affiliation

Person 2

First Name

Last Name

Affiliation

Person 3

First Name

Last Name

Affiliation

Person 4

First Name

Last Name

Affiliation

Basic Information

A comprehensive README file is REQUIRED.

Model Name / Project Title

Model Fee

Model Image

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Date model first developed

Date of Model’s Last Update

Is this model a modified version of one already cataloged in HModEx™ or elsewhere?

Yes

Not sure

If yes, please specify the source or repository where the original model can be found (e.g., HModEx™ link, GitHub, journal publication)

GitHub

Harvard Dataverse

HModEx™

Journal publication

OSF.io

Tufts CEA Registry

Zenodo

Mendeley Data

Other

Primary Country

Primary Setting or Model Context

Clinical care – Primary care (e.g., general practice, chronic disease screening)

Clinical care – Specialty / Hospital care (e.g., oncology, cardiology, inpatient care)

Clinical care – Hospital / Acute care

Public health / Population-level

Health policy / Government decision-making

Health technology assessment (HTA) / Reimbursement

Payer / Insurance

Pharmaceutical / Industry

Academic / Research / Teaching

Other

What software was used to implement the mode?

Microsoft Excel

R (e.g., heemod, BCEA, dampack, hesim)

Python (e.g., SimPy, scikit-HE)

TreeAge

MATLAB

Stata

SAS

Custom web-based platform

Other

Does this model have any ownership or licensing restrictions that limit its sharing, reuse, or modification?

Yes, it has some restrictions

No, it is fully open-source and reusable

Not sure

What type license applies to this model?

Open-source (e.g., MIT, GPL)

Creative Commons (e.g., CC-BY, CC-BY-NC)

Institutional/commercial license

No license specified

Not sure

Other

Model Sponsor

Government agency

Academic institution

Healthcare organization

Nonprofit / NGO

Pharmaceutical or medical device company

Independent / self-funded

Unknown

Other

Does your submission include a README file that explains how to run and understand the model?

Yes

Is code annotated?

Yes

Detail

Please include detail.

Model Background and Intended Use

Model Type

Decision tree

Markov cohort model

Markov microsimulation (individual-level state transition)

Discrete event simulation (DES)

System dynamics model

Partitioned survival model (e.g., 3-state oncology model)

Budget impact model

Cost calculator / static model

Epidemiologic model (e.g., transmission, SIR/SEIR)

Regression-based model (e.g., risk prediction, extrapolation)

Hybrid model (combination of methods)

Other

Primary disease Focus

Methods

What is the target population for this model?

Disease trajectory/scope

Intervention (Primary intervention focus of model)

Intervention(s)

Comparator

Abiraterone followed by docetaxel

Bortezomib, lenalidomide, and dexamethasone

BRAF molecular testing

Cabozantinib plus nivolumab

Carbo/Gem in first line followed by IO

Chlorambucil plus obinutuzumab

Cis/gem followed by IO vs carbo/gem followed by IO

Continuous cetuximab

Current practice (ie, individual clinicians deciding which potential donors with PBM to accept or decline)

Current UK national breast screening programs

Dabrafenib

Dacarbazine

Daratumumab, lenalidomide, and dexamethasone

Digital Breast Tomosynthesis

Docetaxel followed by abiraterone

Erlotinib

Gefitinib

Increase utilization of kidneys

Intermittent cetuximab

Mammography

Nivolumab + ipilimumab

No CDX2 testing and no adjuvant chemotherapy for any patient

No molecular testing

No pembrolizumab

No screening

Nutrition Policy

Other

Patients referred by traditional criteria

Pembrolizumab

Pembrolizumab plus lenvatinib

Screening

Standard of care

Stratified screening

Universal screening

Venetoclax

Whole-genome sequencing

Country

United States

Canada

United Kingdom

European Union (EU, general)

Australia / New Zealand

China

Japan

India

Sub-Saharan Africa

Latin America

Middle East / North Africa

Southeast Asia

None

Other

What is the time horizon used in the model? (Select one and specify the exact duration, if applicable.)

Lifetime

Fixed long-term (e.g., ≥10 years)

Medium-term (e.g., 5–10 years)

Short-term (e.g., < 5 years)

Not applicable

Other

What discount rate(s) were applied in the model?

What outcomes does the model generate or report? (Select all that apply and specify others, if needed. Include both clinical and economic outcomes.)

Predicted clinical outcomes (e.g., disease progression, survival, complications)

Life years (LYs)

Quality-adjusted life years (QALYs) — selected

Disability-adjusted life years (DALYs)

Costs (e.g., total cost, cost per patient)

Net benefits (NBs or net monetary benefit, NMB)

Incremental cost-effectiveness ratios (ICERs)

Budget impact

Resource use (e.g., hospitalizations, visits)

Productivity loss or societal outcomes

Other

What are the key results or findings from the model?

What are the key conclusions or current applications of this model?

Is this model currently being used in any additional relevant contexts?

HTA review

Regulatory submissions

Commercialization

Stakeholder engagement

Academic research

Other

Document Upload

Upload your model’s related files.
The model’s native code files and individual file uploads may not exceed 50MBs each.
If upload exceeds 50MBs, please contact Stella Wang at stellapwang@northwestern.edu for options.
Optional uploads/links include publications, posters, technical reports, or presentations applicable to your model.

Download the CADTH Tool For Model Validation.

Once downloaded, please complete, scan and attach by clicking the button below.

After you upload your completed model validation tool and enter your model validation score, please press Next (at the bottom of this page) and then Submit Form (on the next page) to save your changes.

Upload CADTH Model Validation Tool

Validation Score (Percent Yeses)

Upload Model zip (include code, input data, and output data)

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Select Premium Paid Option(s)

Type of licensing (paid/free)

Additional Data (Univ of Maryland or MSSM)

Breakdown of CADTH (CDA-AMC) Model Validation Score (i.e., Individual Metrics)

Premium Model Validation (i.e., Using AdVISHE model validation tool)

Was the Cheers 2022 checklist used to guide the reporting of this model or its result?

Yes – Fully allowed

Partially allowed

Not applicable

Not sure

CHEERS Checklist (https://www.equator-network.org/reporting-guidelines/cheers/)

CHEERS Checklist File

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Licensing a model
HModEx™ is being used to share open source software. For your model to truly be open source, you’ll need to license it so that others are free to use, change, and distribute the software, unless we have a separate agreement with you to, e.g, use paid modules. The hyperlink includes more information about choosing a license and other relevant information. (Licensing Options)

Licensing information

Our staff will review your submission to ensure that it is within scope for the platform, and that you have included all required information. Your model and code will be posted as a project on the ModEx™ Platform (website address to add). We will follow up via email when we have posted your model.

I consent to have my model reviewed on quality and its results to be published on the HModEx™ platform. You need to check the box to publish your model to HModEx™.
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SUBMIT:
Our staff will review your submission to ensure that it is within scope for the platform, and that you have included all required information. Your model and code will be posted on the HModEx™ platform. We will follow up via email when we have posted your model.