Economic Models of Colorectal Cancer Screening in Average-Risk Adults Workshop Summary (2005) / Chapter Skim
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Appendix E Description of the Laudabaum Colorectal Cancer Screening Model--Uri Ladabaum, M.D., M.S.
Appendix E Description of the Laudabaum Colorectal Cancer Screening Model--Uri Ladabaum, M.D., M.S.
Pages 61-72
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Appendix E Description of the Laudabaum Colorectal Cancer Screening Model Uri Ladabaum, M.D., M.S. SLIDE 1 SLIDE 1 NOTES: This summary describes key elements of the current version of a model used in a cost-effectiveness analysis published by my colleagues and me (Song et al., 2004)
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The model can incorporate stopping ages up to age 100. It is also possible to treat each sex separately, though most of our work has been with average values for the entire population.
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Some patients can progress directly from the normal state to localized colorectal cancer. In our model, approximately 85 percent of colorectal cancers arise from the adenoma-to-carcinoma sequence.
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(It turns out that a fixed transition rate fits the data well, which is biologically plausible.) We assumed a dwelling time of 2 years each in localized and regional cancer, rates of symptomatic presentation derived to match SEER stage distribution (22%/yr for localized and 40%/yr for regional; 100% for distant)
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. The graphs above show how the predictions from our model so calibrated compare to the average of the published data on polyp prevalence for men and women.
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66 ECONOMIC MODELS OF COLORECTAL CANCER SCREENING SLIDE 6 SLIDE 6 NOTES: The graphs in this slide show how the model, as calibrated by SEER data (Ries et al., 1997) , compares to the age- and stage-specific incidence rates.
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However, the incremental costeffectiveness ratios and rankings across strategies would be affected if compliance rates vary across strategies. Definitions: ICE = incremental cost-effectiveness.
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In addition, those costs could be age-dependent, if reasonable data were available.
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APPENDIX E 69 SLIDE 9 SLIDE 9 NOTES: To validate the model, we examined the age-specific outcomes of the model and compared them with national data for the year 2000. We were gratified that the estimated number of cancer cases in our model is consistent with published data (Jemal et al., 2003; Sandler et al., 2002)
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With full adherence with yearly FOBT, our model predicts approximately double the reductions in cancer incidence and mortality that were observed in the Minnesota trial. For sigmoidoscopy every 5 years, our model predicts a 56 percent reduction in colorectal cancer incidence.
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independent annual FOBT at 40% sensitivity for cancer has only a 0.6x0.6x0.6x0.6 = 13% chance of not picking up a cancer at some point before it is distant if cancer dwells in localized x 2 years and regional x 2 years) As the model is currently structured, transitions among most patient states are probabilistic.
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: 13651371. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM.
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