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Wang J, Pouwels X, Ramaekers B, Frederix G, van Lieshout C, Hoogenveen R, Li X, de Wit GA, Joore M, Koffijberg H, van Giessen A, Knies S, Feenstra T. A Blueprint for Multi-use Disease Modeling in Health Economics: Results from Two Expert-Panel Consultations. PHARMACOECONOMICS 2024; 42:797-810. [PMID: 38613660 PMCID: PMC11180025 DOI: 10.1007/s40273-024-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The current use of health economic decision models in HTA is mostly confined to single use cases, which may be inefficient and result in little consistency over different treatment comparisons, and consequently inconsistent health policy decisions, for the same disorder. Multi-use disease models (MUDMs) (other terms: generic models, whole disease models, disease models) may offer a solution. However, much is uncertain about their definition and application. The current research aimed to develop a blueprint for the application of MUDMs. METHODS We elicited expert opinion using a two-round modified Delphi process. The panel consisted of experts and stakeholders in health economic modelling from various professional backgrounds. The first questionnaire concerned definition, terminology, potential applications, issues and recommendations for MUDMs and was based on an exploratory scoping review. In the second round, the panel members were asked to reconsider their input, based on feedback regarding first-round results, and to score issues and recommendations for priority. Finally, adding input from external advisors and policy makers in a structured way, an overview of issues and challenges was developed during two team consensus meetings. RESULTS In total, 54 respondents contributed to the panel results. The term 'multi-use disease models' was proposed and agreed upon, and a definition was provided. The panel prioritized 10 potential applications (with comparing alternative policies and supporting resource allocation decisions as the top 2), while 20 issues (with model transparency and stakeholders' roles as the top 2) were identified as challenges. Opinions on potential features concerning operationalization of multi-use models were given, with 11 of these subsequently receiving high priority scores (regular updates and revalidation after updates were the top 2). CONCLUSIONS MUDMs would improve on current decision support regarding cost-effectiveness information. Given feasibility challenges, this would be most relevant for diseases with multiple treatments, large burden of disease and requiring more complex models. The current overview offers policy makers a starting point to organize the development, use, and maintenance of MUDMs and to support choices concerning which diseases and policy decisions they will be helpful for.
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Affiliation(s)
- Junfeng Wang
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Xavier Pouwels
- Department of Health Technology and Services Research, Faculty of Behavioural, Management, and Social Sciences, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Geert Frederix
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris van Lieshout
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rudolf Hoogenveen
- Department of Statistics, Modelling and Data Science, Center of Research and Data services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Xinyu Li
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - G Ardine de Wit
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam & Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management, and Social Sciences, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Anoukh van Giessen
- Department of Statistics, Modelling and Data Science, Center of Research and Data services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Saskia Knies
- National Health Care Institute, Diemen, The Netherlands
| | - Talitha Feenstra
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.
- Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Hsu WF, Chiu HM. Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives. Dig Endosc 2023; 35:822-834. [PMID: 37381701 DOI: 10.1111/den.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
Colonoscopy is crucial in preventing colorectal cancer (CRC) and reducing associated mortality. This comprehensive review examines the importance of high-quality colonoscopy and associated quality indicators, including bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate (ADR), complete resection, specimen retrieval, complication rates, and patient satisfaction, while also discussing other ADR-related metrics. Additionally, the review draws attention to often overlooked quality aspects, such as nonpolypoid lesion detection, as well as insertion and withdrawal skills. Moreover, it explores the potential of artificial intelligence in enhancing colonoscopy quality and highlights specific considerations for organized screening programs. The review also emphasizes the implications of organized screening programs and the need for continuous quality improvement. A high-quality colonoscopy is crucial for preventing postcolonoscopy CRC- and CRC-related deaths. Health-care professionals must develop a thorough understanding of colonoscopy quality components, including technical quality, patient safety, and patient experience. By prioritizing ongoing evaluation and refinement of these quality indicators, health-care providers can contribute to improved patient outcomes and develop more effective CRC screening programs.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Zheng S, Schrijvers JJA, Greuter MJW, Kats-Ugurlu G, Lu W, de Bock GH. Effectiveness of Colorectal Cancer (CRC) Screening on All-Cause and CRC-Specific Mortality Reduction: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15071948. [PMID: 37046609 PMCID: PMC10093633 DOI: 10.3390/cancers15071948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: The aim of this study was to pool and compare all-cause and colorectal cancer (CRC) specific mortality reduction of CRC screening in randomized control trials (RCTs) and simulation models, and to determine factors that influence screening effectiveness. (2) Methods: PubMed, Embase, Web of Science and Cochrane library were searched for eligible studies. Multi-use simulation models or RCTs that compared the mortality of CRC screening with no screening in general population were included. CRC-specific and all-cause mortality rate ratios and 95% confidence intervals were calculated by a bivariate random model. (3) Results: 10 RCTs and 47 model studies were retrieved. The pooled CRC-specific mortality rate ratios in RCTs were 0.88 (0.80, 0.96) and 0.76 (0.68, 0.84) for guaiac-based fecal occult blood tests (gFOBT) and single flexible sigmoidoscopy (FS) screening, respectively. For the model studies, the rate ratios were 0.45 (0.39, 0.51) for biennial fecal immunochemical tests (FIT), 0.31 (0.28, 0.34) for biennial gFOBT, 0.61 (0.53, 0.72) for single FS, 0.27 (0.21, 0.35) for 10-yearly colonoscopy, and 0.35 (0.29, 0.42) for 5-yearly FS. The CRC-specific mortality reduction of gFOBT increased with higher adherence in both studies (RCT: 0.78 (0.68, 0.89) vs. 0.92 (0.87, 0.98), model: 0.30 (0.28, 0.33) vs. 0.92 (0.51, 1.63)). Model studies showed a 0.62-1.1% all-cause mortality reduction with single FS screening. (4) Conclusions: Based on RCTs and model studies, biennial FIT/gFOBT, single and 5-yearly FS, and 10-yearly colonoscopy screening significantly reduces CRC-specific mortality. The model estimates are much higher than in RCTs, because the simulated biennial gFOBT assumes higher adherence. The effectiveness of screening increases at younger screening initiation ages and higher adherences.
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Affiliation(s)
- Senshuang Zheng
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Jelle J A Schrijvers
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Marcel J W Greuter
- Medical Center Groningen, Department of Radiology, University of Groningen, 9700 RB Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Technical Medical Centre, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, 7522 NH Enschede, The Netherlands
| | - Gürsah Kats-Ugurlu
- Medical Center Groningen, Department of Pathology, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin 300070, China
| | - Geertruida H de Bock
- Medical Center Groningen, Department of Epidemiology, University of Groningen, 9700 RB Groningen, The Netherlands
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Anderson JC, Hisey W, Mackenzie TA, Robinson CM, Srivastava A, Meester RGS, Butterly LF. Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; 96:310-317. [PMID: 35276209 PMCID: PMC9296608 DOI: 10.1016/j.gie.2022.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR. METHODS We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination. RESULTS One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%. CONCLUSIONS Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.
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Affiliation(s)
- Joseph C. Anderson
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- White River Junction VAMC, White River Junction, Vermont, USA
| | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Todd A. Mackenzie
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Christina M. Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Amitabh Srivastava
- Department of Pathology, Memorial Sloane Kettering Cancer Center, New York, New York, USA
| | - Reinier G. S. Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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Lew JB, Greuter MJE, Caruana M, He E, Worthington J, St John DJ, Macrae FA, Feletto E, Coupé VMH, Canfell K. Validation of Microsimulation Models against Alternative Model Predictions and Long-Term Colorectal Cancer Incidence and Mortality Outcomes of Randomized Controlled Trials. Med Decis Making 2020; 40:815-829. [PMID: 32845232 DOI: 10.1177/0272989x20944869] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. This study aimed to assess the validity of 2 microsimulation models of colorectal cancer (CRC), Policy1-Bowel and ASCCA. Methods. The model-estimated CRC risk in population subgroups with different health statuses, "dwell time" (time from incident precancerous polyp to symptomatically detected CRC), and reduction in symptomatically detected CRC incidence after a one-time complete removal of polyps and/or undetected CRC were compared with published findings from 3 well-established models (MISCAN, CRC-SPIN, and SimCRC). Furthermore, 6 randomized controlled trials (RCTs) that provided screening using a guaiac fecal occult blood test (Funen trial, Burgundy trial, and Minnesota Colon Cancer Control Study [MCCCS]) or flexible sigmoidoscopy (NORCCAP, SCORE, and UKFSST) with long-term follow-up were simulated. Model-estimated long-term relative reductions of CRC incidence (RRinc) and mortality (RRmort) were compared with the RCTs' findings. Results. The Policy1-Bowel and ASCCA estimates showed more similarities to CRC-SPIN and SimCRC. For example, overall dwell times estimated by Policy1-Bowel (24.0 years) and ASCCA (25.3) were comparable to CRC-SPIN (25.8) and SimCRC (25.2) but higher than MISCAN (10.6). In addition, ∼86% of Policy1-Bowel's and ∼74% of ASCCA's estimated RRinc and RRmort were consistent with the RCTs' long-term follow-up findings. For example, at 17 to 18 years of follow-up, the MCCCS reported RRmort of 0.67 (95% confidence interval [CI], 0.51-0.83) and 0.79 (95% CI, 0.62-0.97) for the annual and biennial screening arm, respectively, and the UKFSST reported RRmort of 0.70 (95% CI, 0.62-0.79) for CRC at all sites and 0.54 (95% CI, 0.46-0.65) for distal CRC. The corresponding model estimates were 0.65, 0.74, 0.81, and 0.61, respectively, for Policy1-Bowel and 0.65, 0.70, 0.75, and 0.58, respectively, for ASCCA. Conclusion. Policy1-Bowel and ASCCA's estimates are largely consistent with the data included for comparisons, which indicates good model validity.
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Affiliation(s)
- Jie-Bin Lew
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Marjolein J E Greuter
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Michael Caruana
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Emily He
- Prince of Wales Clinical School, University of NSW, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | | | - D James St John
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia.,Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Finlay A Macrae
- Department of Colorectal Medicine and Genetics, and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, New South Wales, Australia
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Karen Canfell
- School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, New South Wales, Australia
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