TY - JOUR
T1 - Modeling Personalized Adjuvant TreaTment in EaRly stage coloN cancer (PATTERN)
AU - Jongeneel, Gabrielle
AU - Greuter, Marjolein J.E.
AU - van Erning, Felice N.
AU - Koopman, Miriam
AU - Medema, Jan P.
AU - Kandimalla, Raju
AU - Goel, Ajay
AU - Bujanda, Luis
AU - Meijer, Gerrit A.
AU - Fijneman, Remond J.A.
AU - van Oijen, Martijn G.H.
AU - Ijzermans, Jan
AU - Punt, Cornelis J.A.
AU - Vink, Geraldine R.
AU - Coupé, Veerle M.H.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Aim: 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. Methods: 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. Results: 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. Conclusion: 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.
AB - Aim: 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. Methods: 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. Results: 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. Conclusion: 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.
KW - Adjuvant chemotherapy
KW - Colon cancer
KW - Markov cohort model
KW - Survival analysis
UR - http://www.scopus.com/inward/record.url?scp=85085388103&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10198-020-01199-4
DO - https://doi.org/10.1007/s10198-020-01199-4
M3 - Article
C2 - 32458162
SN - 1618-7598
VL - 21
SP - 1059
EP - 1073
JO - European Journal of Health Economics
JF - European Journal of Health Economics
IS - 7
ER -