Mortality Modeling of Early Detection Programs

Lee, Sandra J.; Zelen, Marvin

doi:10.1111/j.1541-0420.2007.00893.x

Cited by 19 publications

(26 citation statements)

References 14 publications

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“…We used the probabilistic model developed by Lee and Zelen (LZ), which has been described elsewhere [11]–[13]. Further details of the model can be found in Appendix S1, section A.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

et al. 2014

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The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.

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“…We used the probabilistic model developed by Lee and Zelen (LZ), which has been described elsewhere [11]–[13]. Further details of the model can be found in Appendix S1, section A.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

et al. 2014

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“…1 has only been reported in [7]. In contrast to existing state models with a compartment preceding the diagnosis, typically called preclinical state [15, 16], our model includes the possibility of dying from the undiagnosed (preclinical) state. In diabetes, there is a considerably increased mortality from this state [12].…”

Section: Discussionmentioning

confidence: 99%

Comparison of surveillance-based metrics for the assessment and monitoring of disease detection: simulation study about type 2 diabetes

Brinks

Hoyer

Rolka

et al. 2017

BMC Med Res Methodol

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BackgroundScreening and detection of cases are a common public health priority for treatable chronic conditions with long subclinical periods. However, the validity of commonly-used metrics from surveillance systems for rates of detection (or case-finding) have not been evaluated.MethodsUsing data from a Danish diabetes register and a recently developed illness-death model of chronic diseases with subclinical conditions, we simulate two scenarios of different performance of case-finding. We report different epidemiological indices to assess case-finding in both scenarios and compare the validity of the results.ResultsThe commonly used ratio of detected cases over total cases may lead to misleading conclusions. Instead, the ratio of undetected cases over persons without a diagnosis is a more valid index to distinguish the quality of case-finding. However, incidence-based measures are preferable to prevalence based indicators.ConclusionPrevalence-based indices for assessing case-finding should be interpreted with caution. If possible, incidence-based indices should be preferred.Electronic supplementary materialThe online version of this article (doi:10.1186/s12874-017-0328-2) contains supplementary material, which is available to authorized users.

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“…In the LZ model, ductal carcinoma in situ (DCIS) cases were not included. The details and the equations for the LZ model can be found in previously published works [6], [7], [8] and in Appendix S1. We previously obtained inputs and modified some equations in the model for the Catalan population [9], [10], [11], [12], [13].…”

Section: Methodsmentioning

confidence: 99%

Contribution of Early Detection and Adjuvant Treatments to Breast Cancer Mortality Reduction in Catalonia, Spain

2012

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BackgroundReductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia.Methodology/Principal FindingsA stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975–2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30–69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%.Conclusions/SignificanceScreening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.

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Mortality Modeling of Early Detection Programs

Cited by 19 publications

References 14 publications

Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

Comparison of surveillance-based metrics for the assessment and monitoring of disease detection: simulation study about type 2 diabetes

Contribution of Early Detection and Adjuvant Treatments to Breast Cancer Mortality Reduction in Catalonia, Spain

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