Simulation of Medical Decisions - cceHUB医疗决策ccehub仿真.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Verification, Calibration Verification Program execution “Trace” analysis “Calibration” Matching Output Targets: Measuring “Goodness-of-Fit” Average error Maximum error Visual “smoothness of fit” Fitting Procedure Fit Cancer Incidence by adjusting Adenoma progression variables Repeat initial step if risk adjustment makes error for people with adenomas too high Fit People with Adenomas by adjusting incidence function Fit Adenoma Prevalence by adjusting Risk function Fit Percent of advanced adenomas to all adenomas Validation Overall characteristics SEER Data, Life-Table, Prior Model Screening validation: Minnesota Colon Cancer Control Study Use FOBT relative to no screening (from 1975 through 1977 and followed until 1991 Randomized trial of three groups: annual screening, biennial screening, and no screening Simulated population fit to Minnesota trial population and some parameters had to be modified to be consistent with the inputs reported Numerical Comparisons Strategy Simulation Cancer Death Trial Cancer Death Mean Standard Deviation Lower Bound Upper Bound Control Group 125 13.63 121 130 121 Annual Group 89 9.37 86 92 82 Result: Health and Cost Burden of CRC Gender Race Family history Life Years Lost QALYs Lost Costs of CRC Female Black No Family history 10.83 (0.08) 10.24 (0.07) $123,714 (3736) Female Black Family history 11.23 (0.06) 10.62 (0.05) $114,381 (2408) Female White No Family history 11.68 (0.07) 10.99 (0.06) $124,875 (3320) Female White Family history 12.15 (0.05) 11.45 (0.05) $118,188 (2283) Male Black No Family history 10.19 (0.07) 9.74 (0.07) $110,460 (3188) Male Black Family history 10.62 (0.05) 10.18 (0.05) $113,317 (2326) Male White No Family history 9.90 (0.06) 9.52 (0.06) $126,345 (3290) Male White Family history 10.29 (0.05) 9.91 (0.04) $123,590 (2283) Result: Effect of Colonoscopy Screening Δ Cost Δ LifeYears (0,0) $500 .100 .0