Prakash Meher K, Lang Brian, Heinrich Henriette, Valli Piero V, Bauerfeind Peter, Sonnenberg Amnon, Beerenwinkel Niko, Misselwitz Benjamin
Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland.
Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland.
BMC Med Inform Decis Mak. 2017 Jun 5;17(1):80. doi: 10.1186/s12911-017-0458-9.
Colorectal cancer (CRC) is a leading cause of cancer-related mortality. CRC incidence and mortality can be reduced by several screening strategies, including colonoscopy, but randomized CRC prevention trials face significant obstacles such as the need for large study populations with long follow-up. Therefore, CRC screening strategies will likely be designed and optimized based on computer simulations. Several computational microsimulation tools have been reported for estimating efficiency and cost-effectiveness of CRC prevention. However, none of these tools is publicly available. There is a need for an open source framework to answer practical questions including testing of new screening interventions and adapting findings to local conditions.
We developed and implemented a new microsimulation model, Colon Modeling Open Source Tool (CMOST), for modeling the natural history of CRC, simulating the effects of CRC screening interventions, and calculating the resulting costs. CMOST facilitates automated parameter calibration against epidemiological adenoma prevalence and CRC incidence data.
Predictions of CMOST were highly similar compared to a large endoscopic CRC prevention study as well as predictions of existing microsimulation models. We applied CMOST to calculate the optimal timing of a screening colonoscopy. CRC incidence and mortality are reduced most efficiently by a colonoscopy between the ages of 56 and 59; while discounted life years gained (LYG) is maximal at 49-50 years. With a dwell time of 13 years, the most cost-effective screening is at 59 years, at $17,211 discounted USD per LYG. While cost-efficiency varied according to dwell time it did not influence the optimal time point of screening interventions within the tested range.
Predictions of CMOST are highly similar compared to a randomized CRC prevention trial as well as those of other microsimulation tools. This open source tool will enable health-economics analyses in for various countries, health-care scenarios and CRC prevention strategies. CMOST is freely available under the GNU General Public License at https://gitlab.com/misselwb/CMOST.
结直肠癌（CRC）是癌症相关死亡的主要原因。包括结肠镜检查在内的多种筛查策略可降低CRC的发病率和死亡率，但随机化的CRC预防试验面临重大障碍，如需要大量研究人群并进行长期随访。因此，CRC筛查策略可能会基于计算机模拟来设计和优化。已有多种计算微模拟工具用于评估CRC预防的效率和成本效益。然而，这些工具均未公开可用。需要一个开源框架来回答实际问题，包括测试新的筛查干预措施以及使研究结果适用于当地情况。
我们开发并实施了一种新的微模拟模型，即结肠建模开源工具（CMOST），用于模拟CRC的自然病史、模拟CRC筛查干预措施的效果并计算相应成本。CMOST有助于根据流行病学腺瘤患病率和CRC发病率数据进行自动参数校准。
与一项大型内镜CRC预防研究以及现有微模拟模型的预测结果相比，CMOST的预测结果高度相似。我们应用CMOST计算筛查结肠镜检查的最佳时机。56至59岁之间进行结肠镜检查可最有效地降低CRC发病率和死亡率；而在49至50岁时获得的贴现生命年（LYG）最大。在停留时间为13年的情况下，最具成本效益的筛查年龄为59岁，每LYG的贴现成本为17,211美元。虽然成本效益根据停留时间而有所不同，但在测试范围内它并未影响筛查干预措施的最佳时间点。
与随机化的CRC预防试验以及其他微模拟工具相比，CMOST的预测结果高度相似。这种开源工具将能够针对不同国家、医疗保健场景和CRC预防策略进行卫生经济学分析。CMOST可根据GNU通用公共许可证在https://gitlab.com/misselwb/CMOST上免费获取。
