Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN).
Age Factors
Aged
Aged, 80 and over
Biomarkers, Tumor
Chemotherapy, Adjuvant
/ economics
Colonic Neoplasms
/ drug therapy
Cost-Benefit Analysis
Disease-Free Survival
Female
Health Care Rationing
Humans
Lymphatic Metastasis
Male
Markov Chains
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Netherlands
Practice Guidelines as Topic
Quality-Adjusted Life Years
Reproducibility of Results
Adjuvant chemotherapy
Colon cancer
Markov cohort model
Survival analysis
Journal
The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
19
08
2019
accepted:
13
05
2020
pubmed:
28
5
2020
medline:
16
6
2021
entrez:
28
5
2020
Statut:
ppublish
Résumé
To develop a decision model for the population-level evaluation of strategies to improve the selection of stage II colon cancer (CC) patients who benefit from adjuvant chemotherapy. A Markov cohort model with a one-month cycle length and a lifelong time horizon was developed. Five health states were included; diagnosis, 90-day mortality, death other causes, recurrence and CC death. Data from the Netherlands Cancer Registry were used to parameterize the model. Transition probabilities were estimated using parametric survival models including relevant clinical and pathological covariates. Subsequently, biomarker status was implemented using external data. Treatment effect was incorporated using pooled trial data. Model development, data sources used, parameter estimation, and internal and external validation are described in detail. To illustrate the use of the model, three example strategies were evaluated in which allocation of treatment was based on (A) 100% adherence to the Dutch guidelines, (B) observed adherence to guideline recommendations and (C) a biomarker-driven strategy. Overall, the model showed good internal and external validity. Age, tumor growth, tumor sidedness, evaluated lymph nodes, and biomarker status were included as covariates. For the example strategies, the model predicted 83, 87 and 77 CC deaths after 5 years in a cohort of 1000 patients for strategies A, B and C, respectively. This model can be used to evaluate strategies for the allocation of adjuvant chemotherapy in stage II CC patients. In future studies, the model will be used to estimate population-level long-term health gain and cost-effectiveness of biomarker-based selection strategies.
Identifiants
pubmed: 32458162
doi: 10.1007/s10198-020-01199-4
pii: 10.1007/s10198-020-01199-4
pmc: PMC7423797
doi:
Substances chimiques
Biomarkers, Tumor
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1059-1073Subventions
Organisme : ZonMw
ID : ZONMW_848015007
Pays : Netherlands
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