A Lung Cancer Policy Model

描述（由申请人提供）：拟议研究的目标是在正在进行的临床试验结果可用之前，开发一种能够在未来几年内指导筛查政策决策的肺癌模型。通过对选定目标人群中的大量个体进行蒙特卡罗模拟，该模型将对螺旋CT和胸部X射线成像等拟议筛查技术的健康和经济后果进行估计。 该模型的大部分价值在于将短期试验结果转化为终身健康和经济后果。将整合来自不同来源的数据，包括过去和正在进行的筛选试验，以获得稳健的参数估计值。一个潜在的自然史部分将模拟癌症和良性病变的产生和生长，参数来自现有的筛选试验数据，尸检研究和肿瘤生长率的信息。每个个体发生病变的概率将由风险因素如吸烟史、年龄和性别决定。额外的模型组件将模拟肺癌的检测和治疗，结果将根据患病率筛查和肿瘤登记的现有数据进行校准。通过明确建模肿瘤生长和检测，我们的方法不同于以前的肺癌筛查决策分析。 研究的主要目标是确定拟议和假设的筛查策略的成本效益，检查筛查不同目标人群或使用改进技术进行筛查的经济和健康影响，并进行未包括在正在进行的试验中的比较（例如，螺旋CT筛查对比无筛查，或以不同频率筛查）。该模型还将允许识别阈值性能特征，在此之上，新的筛查方案将是无筛查或螺旋CT筛查的有吸引力的替代方案。通过识别具有较大合理范围和对结果有重要影响的参数，该模型可以作为未来临床试验高效设计的工具。该模型将指导即将到来的筛查政策决策，并与冠心病政策模型的成就相平行，有朝一日可以评估治疗进展或发病率趋势。

DESCRIPTION (provided by applicant): The goal of the proposed research is to develop a lung cancer model capable of guiding screening policy decisions over the next several years, before results of ongoing clinical trials are available. Through Monte Carlo simulations of large numbers of individuals in selected target populations, the model will provide estimates of the health and economic consequences of proposed screening technologies such as helical CT and chest X-ray imaging. Much of the model's value will lie in translating short-term trial results into lifetime health and economic consequences. Data from a diverse array of sources, including past and ongoing screening trials, will be integrated to derive robust parameter estimates. An underlying natural history component will simulate the generation and growth of cancers and benign lesions, with parameters derived from existing screening trial data, autopsy studies, and information on tumor growth rates. Each individual's probability of developing lesions will be determined by risk factors such as smoking history, age, and sex. Additional model components will simulate the detection and treatment of lung cancer, with outcomes calibrated to existing data from prevalence screens and tumor registries. By modeling tumor growth and detection explicitly, our approach differs from previous decision analyses of lung cancer screening. Principal goals of the research are to determine the cost-effectiveness of proposed and hypothetical screening strategies, to examine the economic and health effects of screening different target populations or of screening with improved technologies, and to make comparisons not included in ongoing trials (e.g., helical CT screening vs. no screening, or screening at different frequencies). The model will also allow identification of threshold performance characteristics, above which new screening programs would be attractive alternatives to no screening or to screening with helical CT. By identifying parameters with both large plausible ranges and important effects on results, the model can serve as a tool for use in the efficient design of future clinical trials. The model will guide imminent screening policy decisions, and, paralleling achievements of the coronary heart disease policy model, could one day evaluate treatment advances or incidence trends.