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Validation of Colorectal Cancer Models on Long-term Outcomes from a Randomized Controlled Trial.

Authors :
DeYoreo M
Lansdorp-Vogelaar I
Knudsen AB
Kuntz KM
Zauber AG
Rutter CM
Source :
Medical decision making : an international journal of the Society for Medical Decision Making [Med Decis Making] 2020 Nov; Vol. 40 (8), pp. 1034-1040. Date of Electronic Publication: 2020 Oct 20.
Publication Year :
2020

Abstract

Microsimulation models are often used to predict long-term outcomes and guide policy decisions regarding cancer screening. The United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial examines a one-time intervention of flexible sigmoidoscopy that was implemented before a colorectal cancer (CRC) screening program was established. Long-term study outcomes, now a full 17 y following randomization, have been published. We use the outcomes from this trial to validate 3 microsimulation models for CRC to long-term study outcomes. We find that 2 of 3 models accurately predict the relative effect of screening (the hazard ratios) on CRC-specific incidence 17 y after screening. We find that all 3 models yield predictions of the relative effect of screening on CRC incidence and mortality (i.e., the hazard ratios) that are reasonably close to the UKFSS results. Two of the 3 models accurately predict the relative reduction in CRC incidence 17 y after screening. One model accurately predicted the absolute incidence and mortality rates in the screened group. The models differ in their estimates related to adenoma detection at screening. Although high-quality screening results help to inform models, trials are expensive, last many years, and can be complicated by ethical issues and technological changes across the duration of the trial. Thus, well-calibrated and validated models are necessary to predict outcomes for which data are not available. The results from this validation demonstrate the utility of models in predicting long-term outcomes and in collaborative modeling to account for uncertainty.

Details

Language :
English
ISSN :
1552-681X
Volume :
40
Issue :
8
Database :
MEDLINE
Journal :
Medical decision making : an international journal of the Society for Medical Decision Making
Publication Type :
Academic Journal
Accession number :
33078673
Full Text :
https://doi.org/10.1177/0272989X20961095