Development and Validation of Three Regional Microsimulation Models for Predicting Colorectal Cancer Screening Benefits in Europe

Abstract

Background. Validated microsimulation models have been shown to be useful tools in providing support for colorectal cancer (CRC) screening decisions. Aiming to assist European countries in reducing CRC mortality, we developed and validated three regional models for evaluating CRC screening in Europe. Methods. Microsimulation Screening Analysis–Colon (MISCAN-Colon) model versions for Italy, Slovenia, and Finland were quantified using data from different national institutions. These models were validated against the best available evidence for the effectiveness of screening from their region (when available): the Screening for COlon REctum (SCORE) trial and the Florentine fecal immunochemical test (FIT) screening study for Italy; the Norwegian Colorectal Cancer Prevention (NORCCAP) trial and the guaiac fecal occult blood test (gFOBT) Finnish population-based study for Finland. When published evidence was not available (Slovenia), the model was validated using cancer registry data. Results. Our three models reproduced age-specific CRC incidence rates and stage distributions in the prescreening period. Moreover, the Italian and Finnish models replicated CRC mortality reductions (reasonably) well against the best available evidence. CRC mortality reductions were predicted slightly larger than those observed (except for the Florentine FIT study), but consistently within the corresponding 95% confidence intervals. Conclusions. Our findings corroborate the MISCAN-Colon reliability in supporting decision making on CRC screening. Furthermore, our study provides the model structure for an additional tool (EU-TOPIA CRC evaluation tool: http://miscan.eu-topia.org ) that aims to help policymakers and researchers monitoring or improving CRC screening in Europe.

An Evolutionary Algorithm to Personalize Stool-Based Colorectal Cancer Screening

“…It is an established model, and has been used to inform the American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) guidelines (Knudsen et al, 2020 ). It has been validated on the results of three clinical trials on the effects of screening for colorectal cancer: the United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) trial (DeYoreo et al, 2020 ); the Norwegian Colorectal Cancer Prevention (NORCCAP) trial (Buskermolen et al, 2018 ); and the Screening for Colon and Rectum (SCORE) trial (Gini et al, 2021 ).…”

Cost-effectiveness of colorectal cancer screening in Slovakia

“…For the purpose of our study, we used the webtool based on the MISCAN-colon model (Gini, Buskermolen, et al ., 2021; Gini, van Ravesteyn, et al ., 2021). The MISCAN-colon model is a simulation model for the estimation of the effect of various factors on cancer incidence and mortality (Gini, Buskermolen, et al ., 2021).…”

“…For the purpose of our study, we used the webtool based on the MISCAN-colon model (Gini, Buskermolen, et al ., 2021; Gini, van Ravesteyn, et al ., 2021). The MISCAN-colon model is a simulation model for the estimation of the effect of various factors on cancer incidence and mortality (Gini, Buskermolen, et al ., 2021). The purpose of MISCAN-colon can be described in three specific aims: to simulate colorectal cancer incidence and mortality according to observed figures, to estimate the absolute and relative contribution of current CRC screening on observed cancer incidence and mortality trends, and to predict how changes in CRC screening (screening tests, target age, screening interval, screening participation, invitation coverage) and treatment practices will impact future incidence and mortality.…”

“…Possible events are birth and death of a person, adenoma incidence and transitions from one state of disease to another. MISCAN-colon consists of three parts: demography part, natural history part and the screening part (Gini, Buskermolen, et al ., 2021). MISCAN-Colon has already been used to inform public health policies in several countries across the globe, including the European Union (Cenin et al , 2014; Van Hees et al , 2015; Knudsen et al , 2016; Peterse et al , 2018; Csanádi et al , 2021).…”

“…MISCAN-Colon has already been used to inform public health policies in several countries across the globe, including the European Union (Cenin et al , 2014; Van Hees et al , 2015; Knudsen et al , 2016; Peterse et al , 2018; Csanádi et al , 2021). The structure and underlying assumptions of the model are reported elsewhere (Gini, Buskermolen, et al ., 2021).…”