Abstract：
UNASSIGNED: Insufficient adherence to colorectal cancer (CRC) screening impedes individual and population health benefits, with about one-third of individuals non-adherent to available screening options. The impact of poor adherence is inadequately considered in most health economics models, limiting the evaluation of real-world population-level screening outcomes. This study introduces the CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model, utilizing real-world adherence scenarios to assess the effectiveness of a blood-based test (BBT) compared to existing strategies.
UNASSIGNED: The CAN-SCREEN model evaluates various CRC screening strategies per 1,000 screened individuals for ages 45-75. Adherence is modeled in two ways: (1) full adherence and (2) longitudinally declining adherence. BBT performance is based on recent pivotal trial data while existing strategies are informed using literature. The full adherence model is calibrated using previously published Cancer Intervention and Surveillance Modeling Network (CISNET) models. Outcomes, including life-years gained (LYG), CRC cases averted, CRC deaths averted, and colonoscopies, are compared to no screening.
UNASSIGNED: Longitudinal adherence modeling reveals differences in the relative ordering of health outcomes and resource utilization, as measured by the number of colonoscopies performed per 1,000, between screening modalities. BBT outperforms the fecal immunochemical test (FIT) and the multitarget stool DNA (mtsDNA) test with more CRC deaths averted (13) compared to FIT and mtsDNA (7, 11), more CRC cases averted (27 vs. 16, 22) and higher LYG (214 vs. 157, 199). BBT yields fewer CRC deaths averted compared to colonoscopy (13, 15) but requires fewer colonoscopies (1,053 vs. 1,928).
UNASSIGNED: Due to limited data, the CAN-SCREEN model with longitudinal adherence leverages evidence-informed assumptions for the natural history and real-world longitudinal adherence to screening.
UNASSIGNED: The CAN-SCREEN model demonstrates that amongst non-invasive CRC screening strategies, those with higher adherence yield more favorable health outcomes as measured by CRC deaths averted, CRC cases averted, and LYG.
This study explored the impact of poor adherence to colorectal cancer (CRC) screening, where about one-third of people face barriers to screening. Common models don’t consider real-world adherence, so we introduced the CAN-SCREEN model. It uses real-world data to determine how well a blood-based test (BBT) could work compared to existing tests. We studied people starting CRC screening at age 45. The model looked at two adherence scenarios: assuming everyone follows guidelines, and using real-world data about how people follow screening guidelines over time. The BBT\'s performance was based on a recent study, and we compared it to existing methods using data from the literature. Results per 1,000 simulated patients showed that the BBT outperforms two guideline-recommended stool-based tests, fecal immunochemical test (FIT) and the multitarget stool DNA (mtsDNA) test, with more CRC deaths averted (13) compared to FIT and mtsDNA (7, 11), more CRC cases averted (27 vs. 16, 22) and higher LYG (214 vs. 157, 199). BBT prevents less CRC deaths than colonoscopy (13 vs. 15), but it leads to fewer colonoscopies (1,053 compared to 1,928). Despite some limitations due to limited data, our model relies on informed assumptions for the natural history of CRC and real-world adherence. In conclusion, our CAN-SCREEN model shows that CRC screening strategies combining good test performance with high adherence give better health outcomes. Adding a blood test, which could be easier for people to use, could save lives and reduce the number of colonoscopies needed.
UNASSIGNED: The CAN-SCREEN model evaluates various CRC screening strategies per 1,000 screened individuals for ages 45-75. Adherence is modeled in two ways: (1) full adherence and (2) longitudinally declining adherence. BBT performance is based on recent pivotal trial data while existing strategies are informed using literature. The full adherence model is calibrated using previously published Cancer Intervention and Surveillance Modeling Network (CISNET) models. Outcomes, including life-years gained (LYG), CRC cases averted, CRC deaths averted, and colonoscopies, are compared to no screening.
UNASSIGNED: Longitudinal adherence modeling reveals differences in the relative ordering of health outcomes and resource utilization, as measured by the number of colonoscopies performed per 1,000, between screening modalities. BBT outperforms the fecal immunochemical test (FIT) and the multitarget stool DNA (mtsDNA) test with more CRC deaths averted (13) compared to FIT and mtsDNA (7, 11), more CRC cases averted (27 vs. 16, 22) and higher LYG (214 vs. 157, 199). BBT yields fewer CRC deaths averted compared to colonoscopy (13, 15) but requires fewer colonoscopies (1,053 vs. 1,928).
UNASSIGNED: Due to limited data, the CAN-SCREEN model with longitudinal adherence leverages evidence-informed assumptions for the natural history and real-world longitudinal adherence to screening.
UNASSIGNED: The CAN-SCREEN model demonstrates that amongst non-invasive CRC screening strategies, those with higher adherence yield more favorable health outcomes as measured by CRC deaths averted, CRC cases averted, and LYG.
This study explored the impact of poor adherence to colorectal cancer (CRC) screening, where about one-third of people face barriers to screening. Common models don’t consider real-world adherence, so we introduced the CAN-SCREEN model. It uses real-world data to determine how well a blood-based test (BBT) could work compared to existing tests. We studied people starting CRC screening at age 45. The model looked at two adherence scenarios: assuming everyone follows guidelines, and using real-world data about how people follow screening guidelines over time. The BBT\'s performance was based on a recent study, and we compared it to existing methods using data from the literature. Results per 1,000 simulated patients showed that the BBT outperforms two guideline-recommended stool-based tests, fecal immunochemical test (FIT) and the multitarget stool DNA (mtsDNA) test, with more CRC deaths averted (13) compared to FIT and mtsDNA (7, 11), more CRC cases averted (27 vs. 16, 22) and higher LYG (214 vs. 157, 199). BBT prevents less CRC deaths than colonoscopy (13 vs. 15), but it leads to fewer colonoscopies (1,053 compared to 1,928). Despite some limitations due to limited data, our model relies on informed assumptions for the natural history of CRC and real-world adherence. In conclusion, our CAN-SCREEN model shows that CRC screening strategies combining good test performance with high adherence give better health outcomes. Adding a blood test, which could be easier for people to use, could save lives and reduce the number of colonoscopies needed.
摘要：
■对结肠直肠癌（CRC）筛查的依从性不足会阻碍个人和人群的健康益处，大约三分之一的人不遵守可用的筛查选项。在大多数卫生经济学模型中，依从性差的影响没有得到充分考虑，限制对真实世界人群水平筛查结果的评估。本研究介绍了CAN-SCREEN(结肠直肠cancerSCReeningEconomicsandadherENce)模型，与现有策略相比，利用真实世界的依从性方案来评估基于血液的测试（BBT）的有效性。
CAN-SCREEN模型评估45-75岁的每1,000名筛查个体的各种CRC筛查策略。依从性以两种方式建模：1）完全依从性和2）纵向下降依从性。BBT性能基于最近的关键试验数据，而现有的策略是使用文献提供信息的。使用先前发布的癌症干预和监测建模网络(CISNET)模型来校准完全依从性模型。结果，包括获得的寿命年(LYG)，避免了儿童权利委员会的案件，儿童权利委员会的死亡得以避免，结肠镜检查，与没有筛查相比。
■纵向依从性模型揭示了健康结果和资源利用的相对顺序的差异，通过每1,000例进行结肠镜检查的数量来衡量，在筛选方式之间。与FIT和mtsDNA（7，11）相比，BBT优于粪便免疫化学测试（FIT）和多目标粪便DNA（mtsDNA）测试，避免了更多的CRC死亡（13），避免了更多CRC病例（27例与16，22）和更高的LYG（214vs.157、199）。与结肠镜检查相比，BBT避免了更少的CRC死亡（13，15），但需要更少的结肠镜检查（1,053vs.1,928）。
■由于数据有限，具有纵向依从性的CAN-SCREEN模型利用了自然史和现实世界纵向依从性筛查的循证假设。
■CAN-SCREEN模型表明，在非侵入性CRC筛查策略中，通过避免CRC死亡来衡量，依从性较高的患者会产生更有利的健康结果，避免了儿童权利委员会的案件，LYG
本研究探讨了结直肠癌（CRC）筛查依从性差的影响，大约三分之一的人面临筛查障碍。常见的模型不考虑现实世界的坚持，所以我们介绍了CAN-SCREEN型号。它使用现实世界的数据来确定与现有测试相比，基于血液的测试（BBT）的效果如何。我们研究了在45岁开始CRC筛查的人。该模型研究了两种遵守情况：假设每个人都遵循指导方针，并使用真实世界的数据，了解人们随着时间的推移如何遵循筛查指南。BBT的表现是基于最近的一项研究，并使用文献中的数据将其与现有方法进行了比较。每1000名模拟患者的结果显示，BBT优于两项指南推荐的基于粪便的测试，粪便免疫化学测试（FIT）和多目标粪便DNA（mtsDNA）测试，与FIT和mtsDNA（7，11）相比，避免了更多的CRC死亡（13），避免了更多CRC病例（27例与16，22）和更高的LYG（214vs.157、199）。与结肠镜检查相比，BBT可以减少CRC死亡（13vs.15),但它导致更少的结肠镜检查（1,053与1,928）。尽管由于有限的数据而存在一些限制，我们的模型依赖于对CRC自然史和真实世界依从性的知情假设.总之,我们的CAN-SCREEN模型显示,将良好的测试表现和高依从性相结合的CRC筛查策略可带来更好的健康结局.加上血液测试，这对人们来说更容易使用，可以挽救生命并减少所需的结肠镜检查次数。
CAN-SCREEN模型评估45-75岁的每1,000名筛查个体的各种CRC筛查策略。依从性以两种方式建模：1）完全依从性和2）纵向下降依从性。BBT性能基于最近的关键试验数据，而现有的策略是使用文献提供信息的。使用先前发布的癌症干预和监测建模网络(CISNET)模型来校准完全依从性模型。结果，包括获得的寿命年(LYG)，避免了儿童权利委员会的案件，儿童权利委员会的死亡得以避免，结肠镜检查，与没有筛查相比。
■纵向依从性模型揭示了健康结果和资源利用的相对顺序的差异，通过每1,000例进行结肠镜检查的数量来衡量，在筛选方式之间。与FIT和mtsDNA（7，11）相比，BBT优于粪便免疫化学测试（FIT）和多目标粪便DNA（mtsDNA）测试，避免了更多的CRC死亡（13），避免了更多CRC病例（27例与16，22）和更高的LYG（214vs.157、199）。与结肠镜检查相比，BBT避免了更少的CRC死亡（13，15），但需要更少的结肠镜检查（1,053vs.1,928）。
■由于数据有限，具有纵向依从性的CAN-SCREEN模型利用了自然史和现实世界纵向依从性筛查的循证假设。
■CAN-SCREEN模型表明，在非侵入性CRC筛查策略中，通过避免CRC死亡来衡量，依从性较高的患者会产生更有利的健康结果，避免了儿童权利委员会的案件，LYG
本研究探讨了结直肠癌（CRC）筛查依从性差的影响，大约三分之一的人面临筛查障碍。常见的模型不考虑现实世界的坚持，所以我们介绍了CAN-SCREEN型号。它使用现实世界的数据来确定与现有测试相比，基于血液的测试（BBT）的效果如何。我们研究了在45岁开始CRC筛查的人。该模型研究了两种遵守情况：假设每个人都遵循指导方针，并使用真实世界的数据，了解人们随着时间的推移如何遵循筛查指南。BBT的表现是基于最近的一项研究，并使用文献中的数据将其与现有方法进行了比较。每1000名模拟患者的结果显示，BBT优于两项指南推荐的基于粪便的测试，粪便免疫化学测试（FIT）和多目标粪便DNA（mtsDNA）测试，与FIT和mtsDNA（7，11）相比，避免了更多的CRC死亡（13），避免了更多CRC病例（27例与16，22）和更高的LYG（214vs.157、199）。与结肠镜检查相比，BBT可以减少CRC死亡（13vs.15),但它导致更少的结肠镜检查（1,053与1,928）。尽管由于有限的数据而存在一些限制，我们的模型依赖于对CRC自然史和真实世界依从性的知情假设.总之,我们的CAN-SCREEN模型显示,将良好的测试表现和高依从性相结合的CRC筛查策略可带来更好的健康结局.加上血液测试，这对人们来说更容易使用，可以挽救生命并减少所需的结肠镜检查次数。
