Abstract
BackgroundColorectal 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.MethodsWe 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.ResultsPredictions 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.ConclusionsPredictions 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
Highlights
Colorectal cancer (CRC) is a leading cause of cancer-related mortality
A new microsimulation model for the natural history of CRC We developed Colon Modeling Open Source Tool (CMOST), a microsimulation model to simulate CRC progression and the effect of CRC screening (Fig. 1)
Each individual within the simulated patient population is assigned an individual adenoma risk. The distribution of these risks within the whole population is calibrated to match the frequency of multiple adenomas [49] and matches the frequency of synchronous colorectal cancers of 3.5% of all CRC [57]
Summary
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. Several computational microsimulation tools have been reported for estimating efficiency and cost-effectiveness of CRC prevention. None of these tools is publicly available. Colorectal cancer (CRC) is the second most common deadly cancer in the United States [1] and many other Western countries. It represents an important public health burden in industrialized countries and increasingly in developing countries [2]. Since treatment options for advanced cancer are limited, current public health strategies focus on CRC screening for prevention of mortality. The presence of adenomas is an important risk factor for subsequent CRC [6]
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