A simulation model for evaluating the medical and economic outcomes of screening strategies for colorectal cancer

Abstract

Mathematical models have been shown to be useful in predicting the cost-effectiveness of cancer screening programmes. We designed a computer macro-simulation model aimed at predicting the cost-effectiveness of alternative colorectal cancer screening strategies. This model was built to determine the cost-effectiveness of a biennial screening programme using the Hemoccult test in Burgundy (France). It was validated with data from the Danish randomized study. Estimates of our model showed an extremely close concordance with observed results in the Danish study. The observed mortality reduction was 18.0% and the estimated mortality reduction was 18.4%. Preliminary data from the Burgundy study predict a 14.6% colorectal cancer mortality reduction after 10 years. Sensitivity analyses were performed with different assumptions regarding the participation rates and the lead-time. This model can serve to assess the cost-effectiveness of a variety of screening modalities.

Critical Analysis of Markov Models Used for the Economic Evaluation of Colorectal Cancer Screening: A Systematic Review

“…The surface model strategy (n ¼ 7 of 34 [21%]) used a single Markov model to represent a CRC screening program ( Fig. 3) [47][48][49][50][51][52][53]. A comparison of the main characteristics of both strategies is presented in In most of the deep model studies (n ¼ 20 of 27 [74%]), adenoma dwell time was an output of the model .…”

“…The surface model strategy does not reproduce the natural history of adenoma [47][48][49][50][51][52][53]. Alternatively, the model predicts the number of adenomas that would be diagnosed through screening in each round of the screening program, and CRC incidence is adjusted downward accordingly.…”

Empirically Evaluating Decision-Analytic Models

“…We assessed 44 application articles identified via the literature review, evaluating whether the general recommendations contained in guidelines and review articles were in common practice [6,11,12,35–75]. Of these 44, 25% compared results only to randomized controlled trials, 66% compared results only to observation studies and population registries, and 9% compared results to both types of studies.…”

Building a model to determine the cost-effectiveness of breast cancer screening in France

“…The model was built based on an existing cost‐effectiveness model originally designed to study the impact of colorectal cancer screening in France (Arveux et al . 1998; Lejeune et al. 2003).…”

“…The model was built based on an existing costeffectiveness model originally designed to study the impact of colorectal cancer screening in France (Arveux et al . 1998;Lejeune et al 2003). The model uses decisiontree analysis with Markov techniques (Sonnenberg & Beck 1993) that allow to analyse cumulated costs and effects over a given time period.…”