CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies

BMC Medical Informatics and Decision Making

Technical Advance

Brian Lang¹  Niko Beerenwinkel¹  Peter Bauerfeind²  Benjamin Misselwitz²  Meher K. Prakash²  Henriette Heinrich²  Piero V. Valli²  Amnon Sonnenberg³ 

[1] Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland;SIB Swiss Institute of Bioinformatics, 4058, Basel, Switzerland;Division of Gastroenterology, University Hospital Zurich (USZ), Rämistrasse 100, 8091, Zurich, Switzerland;The Portland VA Medical Center, P3-GI, 3710 SW US Veterans Hospital Road, 97239, Portland, OR, USA;

关键词: Colorectal cancer;    Screening colonoscopies;    Screening intervals;    Cost-effectiveness;    Microsimulation;   

DOI  :  10.1186/s12911-017-0458-9

 received in 2016-10-25, accepted in 2017-04-30,  发布年份 2017

来源: Springer

【 摘 要 】

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

【 授权许可】

CC BY   
© The Author(s). 2017

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