Clarifying differences in natural history between models of screening: the case of colorectal cancer.
| Year: | 2011 | ||||||
| Type of Publication: | Article | ||||||
| Authors: |
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| Journal: | Med Decis Making | Volume: | 31 | ||||
| Number: | 4 | Pages: | 540-549 | ||||
| Abstract: | |||||||
Microsimulation models are important decision support tools for screening.
However, their complexity makes them difficult to understand and
limits realization of their full potential. Therefore, it is important
to develop documentation that clarifies their structure and assumptions.
The authors demonstrate this problem and explore a solution for natural
history using 3 independently developed colorectal cancer screening
models.The authors first project effectiveness and cost-effectiveness
of colonoscopy screening for the 3 models (CRC-SPIN, SimCRC, and
MISCAN). Next, they provide a conventional presentation of each model,
including information on structure and parameter values. Finally,
they report the simulated reduction in clinical cancer incidence
following a one-time complete removal of adenomas and preclinical
cancers for each model. They call this new measure the maximum clinical
incidence reduction (MCLIR).Projected effectiveness varies widely
across models. For example, estimated mortality reduction for colonoscopy
screening every 10 years from age 50 to 80 years, with surveillance
in adenoma patients, ranges from 65\% to 92\%. Given only conventional
information, it is difficult to explain these differences, largely
because differences in structure make parameter values incomparable.
In contrast, the MCLIR clearly shows the impact of model differences
on the key feature of natural history, the dwell time of preclinical
disease. Dwell times vary from 8 to 25 years across models and help
explain differences in projected screening effectiveness.The authors
propose a new measure, the MCLIR, which summarizes the implications
for predicted screening effectiveness of differences in natural history
assumptions. Including the MCLIR in the standard description of a
screening model would improve the transparency of these models. |
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