A systematic comparison of microsimulation models of colorectal cancer: the role of assumptions about adenoma progression.
| Year: | 2011 | ||||||
| Type of Publication: | Article | ||||||
| Authors: |
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| Journal: | Med Decis Making | Volume: | 31 | ||||
| Number: | 4 | Pages: | 530-539 | ||||
| Abstract: | |||||||
As the complexity of microsimulation models increases, concerns about
model transparency are heightened.The authors conducted model "experiments"
to explore the impact of variations in "deep" model parameters using
3 colorectal cancer (CRC) models. All natural history models were
calibrated to match observed data on adenoma prevalence and cancer
incidence but varied in their underlying specification of the adenocarcinoma
process. The authors projected CRC incidence among individuals with
an underlying adenoma or preclinical cancer v. those without any
underlying condition and examined the impact of removing adenomas.
They calculated the percentage of simulated CRC cases arising from
adenomas that developed within 10 or 20 years prior to cancer diagnosis
and estimated dwell time-defined as the time from the development
of an adenoma to symptom-detected cancer in the absence of screening
among individuals with a CRC diagnosis.The 20-year CRC incidence
among 55-year-old individuals with an adenoma or preclinical cancer
was 7 to 75 times greater than in the condition-free group. The removal
of all adenomas among the subgroup with an underlying adenoma or
cancer resulted in a reduction of 30% to 89% in cumulative incidence.
Among CRCs diagnosed at age 65 years, the proportion arising from
adenomas formed within 10 years ranged between 4% and 67%. The
mean dwell time varied from 10.6 to 25.8 years.Models that all match
observed data on adenoma prevalence and cancer incidence can produce
quite different dwell times and very different answers with respect
to the effectiveness of interventions. When conducting applied analyses
to inform policy, using multiple models provides a sensitivity analysis
on key (unobserved) "deep" model parameters and can provide guidance
about specific areas in need of additional research and validation. |
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