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Probabilistic cost-effectiveness comparison of screening strategies for colorectal cancer

Published: 23 March 2009 Publication History

Abstract

A stochastic discrete-event simulation model of the natural history of Colorectal Cancer (CRC) is augmented with screening technology representations to create a base for simulating various screening strategies for CRC. The CRC screening strategies recommended by the American Gastroenterological Association (AGA) and the newest screening strategies for which clinical efficacy has been established are simulated. In addition to verification steps, validation of screening is pursued by comparison with the Minnesota Colon Cancer Control Study. The model accumulates discounted costs and quality-adjusted life-years. The natural variability in the modeled random variables for natural history is conditioned using a probabilistic sensitivity analysis through a two-stage sampling process that adds other random variables representing parametric uncertainty. The analysis of the screening alternatives in a low-risk population explores both deterministic and stochastic dominance to eliminate some screening alternatives. Net benefit analysis, based on willingness to pay for quality-adjusted life-years, is used to compare the most cost-effective strategies through acceptability curves and to make a screening recommendation. Methodologically, this work demonstrates how variability from the natural variation in the development, screening, and treatment of a disease can be combined with the variation in parameter uncertainty. Furthermore, a net benefit analysis that characterizes cost-effectiveness alternatives can explicitly depend on variation from all sources producing a probabilistic cost-effectiveness analysis of decision alternatives.

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    Published In

    cover image ACM Transactions on Modeling and Computer Simulation
    ACM Transactions on Modeling and Computer Simulation  Volume 19, Issue 2
    March 2009
    142 pages
    ISSN:1049-3301
    EISSN:1558-1195
    DOI:10.1145/1502787
    Issue’s Table of Contents
    Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than ACM must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected]

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    Publication History

    Published: 23 March 2009
    Accepted: 01 May 2008
    Revised: 01 October 2007
    Received: 01 March 2007
    Published in TOMACS Volume 19, Issue 2

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    Author Tags

    1. Cost-effectiveness analysis
    2. acceptability curves
    3. colorectal cancer screening strategies
    4. medical decision-making
    5. net benefit analysis
    6. probabilistic sensitivity analysis

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    Cited By

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    • (2019)Evaluating the Cost-Effective Use of Follow-Up Colonoscopy Based on Screening Findings and AgeComputational and Mathematical Methods in Medicine10.1155/2019/24765652019(1-12)Online publication date: 19-Feb-2019
    • (2016)Modeling and Control of Colorectal CancerPLOS ONE10.1371/journal.pone.016134911:8(e0161349)Online publication date: 18-Aug-2016
    • (2014)Using a partially observable Markov chain model to assess colonoscopy screening strategies – A cohort studyEuropean Journal of Operational Research10.1016/j.ejor.2014.03.004238:1(313-326)Online publication date: Oct-2014
    • (2013)A predictive model of longitudinal, patient-specific colonoscopy resultsComputer Methods and Programs in Biomedicine10.1016/j.cmpb.2013.07.007112:3(563-579)Online publication date: 1-Dec-2013
    • (2011)Medical decision making: open research challengesIIE Transactions on Healthcare Systems Engineering10.1080/19488300.2011.6191571:3(161-167)Online publication date: Jul-2011
    • (2008)How much is a health insurer willing to pay for colorectal cancer screening tests?Proceedings of the 40th Conference on Winter Simulation10.5555/1516744.1517029(1624-1631)Online publication date: 7-Dec-2008

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