A Lung Cancer Policy Model

肺癌政策模型

• 批准号: 7290016
• 负责人: G SCOTT GAZELLE
• 金额: $ 8万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-03-01 至 2008-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7290016
• 关键词: cancer registry /resource; cancer risk; computed axial tomography; cost effectiveness; diagnosis service; health care cost /financing; health care model; health care policy; health care service evaluation; health services research tag; human data; human mortality; longevity; lung neoplasms; mass screening; model design /development; neoplasm /cancer epidemiology; neoplasm /cancer radiodiagnosis; neoplastic growth; postmortem; radiography; thoracic radiography

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.

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的结果出来之前，开发一种能够在未来几年指导筛查政策决定的肺癌模型。通过对选定目标人群中的大量个体进行蒙特卡洛模拟，该模型将提供对拟议筛查技术(如螺旋CT和胸部X光成像)的健康和经济后果的估计。 该模型的大部分价值将在于将短期试验结果转化为终生健康和经济后果。来自不同来源的数据，包括过去和正在进行的筛查试验，将被整合以得出可靠的参数估计。一个潜在的自然历史部分将模拟癌症和良性病变的产生和生长，参数来自现有的筛查试验数据、尸检研究和关于肿瘤生长率的信息。每个人发生病变的可能性将由吸烟史、年龄和性别等风险因素决定。其他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。通过对肿瘤生长和检测进行显式建模，我们的方法不同于以前的肺癌筛查决策分析。 这项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利用改进的技术进行筛查的经济和健康影响，并进行不包括在正在进行的试验中的比较(例如，螺旋CT筛查与不筛查，或以不同的频率进行筛查)。该模型还将允许识别阈值性能特征，超过该阈值，新的筛查程序将成为不筛查或螺旋CT筛查的有吸引力的替代方案。通过识别既有大的可信范围又对结果有重要影响的参数，该模型可以作为一种工具用于未来临床试验的有效设计。该模型将指导迫在眉睫的筛查决策，并与冠心病政策模型的成就并行，有朝一日可以评估治疗进展或发病率趋势。

项目成果

Chapter 9: The MGH-HMS lung cancer policy model: tobacco control versus screening.

• DOI: 10.1111/j.1539-6924.2011.01652.x
• 发表时间: 2012-07
• 期刊: Risk analysis : an official publication of the Society for Risk Analysis
• 作者: McMahon PM;Kong CY;Johnson BE;Weinstein MC;Weeks JC;Tramontano AC;Cipriano LE;Bouzan C;Gazelle GS
• 通讯作者: Gazelle GS

Cost-effectiveness of computed tomography screening for lung cancer in the United States.

• DOI: 10.1097/jto.0b013e31822e59b3
• 发表时间: 2011-11
• 期刊: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
• 作者: McMahon PM;Kong CY;Bouzan C;Weinstein MC;Cipriano LE;Tramontano AC;Johnson BE;Weeks JC;Gazelle GS
• 通讯作者: Gazelle GS

Calibration of disease simulation model using an engineering approach.

• DOI: 10.1111/j.1524-4733.2008.00484.x
• 发表时间: 2009-06
• 期刊: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
• 作者: Kong CY;McMahon PM;Gazelle GS
• 通讯作者: Gazelle GS

Using radiation risk models in cancer screening simulations: important assumptions and effects on outcome projections.

• DOI: 10.1148/radiol.11110352
• 发表时间: 2012-03
• 期刊: Radiology
• 影响因子: 19.7
• 作者: C. Kong;Janie M. Lee;P. McMahon;K. Lowry;Z. Omer;Jonathan D. Eisenberg;P. Pandharipande;G. Gazelle