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Validation of Models Used to Inform Colorectal Cancer Screening Guidelines

Author

Listed:
  • Carolyn M. Rutter
  • Amy B. Knudsen
  • Tracey L. Marsh
  • V. Paul Doria-Rose
  • Eric Johnson
  • Chester Pabiniak
  • Karen M. Kuntz
  • Marjolein van Ballegooijen
  • Ann G. Zauber
  • Iris Lansdorp-Vogelaar

Abstract

Background . Microsimulation models synthesize evidence about disease processes and interventions, providing a method for predicting long-term benefits and harms of prevention, screening, and treatment strategies. Because models often require assumptions about unobservable processes, assessing a model’s predictive accuracy is important. Methods . We validated 3 colorectal cancer (CRC) microsimulation models against outcomes from the United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial, a randomized controlled trial that examined the effectiveness of one-time flexible sigmoidoscopy screening to reduce CRC mortality. The models incorporate different assumptions about the time from adenoma initiation to development of preclinical and symptomatic CRC. Analyses compare model predictions to study estimates across a range of outcomes to provide insight into the accuracy of model assumptions. Results . All 3 models accurately predicted the relative reduction in CRC mortality 10 years after screening (predicted hazard ratios, with 95% percentile intervals: 0.56 [0.44, 0.71], 0.63 [0.51, 0.75], 0.68 [0.53, 0.83]; estimated with 95% confidence interval: 0.56 [0.45, 0.69]). Two models with longer average preclinical duration accurately predicted the relative reduction in 10-year CRC incidence. Two models with longer mean sojourn time accurately predicted the number of screen-detected cancers. All 3 models predicted too many proximal adenomas among patients referred to colonoscopy. Conclusion . Model accuracy can only be established through external validation. Analyses such as these are therefore essential for any decision model. Results supported the assumptions that the average time from adenoma initiation to development of preclinical cancer is long (up to 25 years), and mean sojourn time is close to 4 years, suggesting the window for early detection and intervention by screening is relatively long. Variation in dwell time remains uncertain and could have important clinical and policy implications.

Suggested Citation

  • Carolyn M. Rutter & Amy B. Knudsen & Tracey L. Marsh & V. Paul Doria-Rose & Eric Johnson & Chester Pabiniak & Karen M. Kuntz & Marjolein van Ballegooijen & Ann G. Zauber & Iris Lansdorp-Vogelaar, 2016. "Validation of Models Used to Inform Colorectal Cancer Screening Guidelines," Medical Decision Making, , vol. 36(5), pages 604-614, July.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:5:p:604-614
    DOI: 10.1177/0272989X15622642
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    References listed on IDEAS

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    1. James Banks & Alastair Muriel & James Smith, 2010. "Disease prevalence, disease incidence, and mortality in the United States and in England," Demography, Springer;Population Association of America (PAA), vol. 47(1), pages 211-231, March.
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    Cited by:

    1. Andrew Piscitello & Leila Saoud & A Mark Fendrick & Bijan J Borah & Kristen Hassmiller Lich & Michael Matney & A Burak Ozbay & Marcus Parton & Paul J Limburg, 2020. "Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-23, December.

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