van der Meijde Elisabeth, van den Eertwegh Alfons J M, Linn Sabine C, Meijer Gerrit A, Fijneman Remond J A, Coupé Veerle M H
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
Department of Medical Oncology, VU University Medical Centre, Amsterdam, the Netherlands.
Cancer Inform. 2016 Jun 15;15:115-27. doi: 10.4137/CIN.S38122. eCollection 2016.
Recently, new but expensive treatments have become available for metastatic melanoma. These improve survival, but in view of the limited funds available, cost-effectiveness needs to be evaluated. Most cancer cost-effectiveness models are based on the observed clinical events such as recurrence- free and overall survival. Times at which events are recorded depend not only on the effectiveness of treatment but also on the timing of examinations and the types of tests performed. Our objective was to construct a microsimulation model framework that describes the melanoma disease process using a description of underlying tumor growth as well as its interaction with diagnostics, treatments, and surveillance. The framework should allow for exploration of the impact of simultaneously altering curative treatment approaches in different phases of the disease as well as altering diagnostics. The developed framework consists of two components, namely, the disease model and the clinical management module. The disease model consists of a tumor level, describing growth and metastasis of the tumor, and a patient level, describing clinically observed states, such as recurrence and death. The clinical management module consists of the care patients receive. This module interacts with the disease process, influencing the rate of transition between tumor growth states at the tumor level and the rate of detecting a recurrence at the patient level. We describe the framework as the required input and the model output. Furthermore, we illustrate model calibration using registry data and data from the literature.
最近，针对转移性黑色素瘤出现了新的但昂贵的治疗方法。这些方法可提高生存率，但鉴于可用资金有限，需要评估成本效益。大多数癌症成本效益模型基于观察到的临床事件，如无复发生存期和总生存期。记录事件的时间不仅取决于治疗效果，还取决于检查时间和所进行的检测类型。我们的目标是构建一个微观模拟模型框架，该框架使用对潜在肿瘤生长及其与诊断、治疗和监测的相互作用的描述来描述黑色素瘤疾病过程。该框架应允许探索在疾病不同阶段同时改变根治性治疗方法以及改变诊断的影响。所开发的框架由两个部分组成，即疾病模型和临床管理模块。疾病模型包括一个肿瘤层面，描述肿瘤的生长和转移，以及一个患者层面，描述临床观察到的状态，如复发和死亡。临床管理模块包括患者接受的护理。该模块与疾病过程相互作用，影响肿瘤层面肿瘤生长状态之间的转变率以及患者层面检测到复发的速率。我们将框架描述为所需输入和模型输出。此外，我们使用登记数据和文献数据来说明模型校准。
