Med Decis Making - Development of a microsimulation of melanoma mortality for evaluating the effectiveness of population-based skin cancer screening.

Tópicos

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Resumo

CKGROUND: A nationwide skin cancer screening (SCS) was implemented in Germany in 2008. It aims at improving early detection of melanoma in order to reduce melanoma mortality. While the idea of early detection is compelling, demonstrating the effectiveness of melanoma screening is crucial. Since it is not feasible to conduct epidemiological studies to investigate the impact of factors such as screening interval or targeted age groups, we developed a microsimulation model that is able to predict melanoma mortality in Germany under several SCS conditions.METHODS: Using German cancer registry data, population data, and other published data on melanoma progression and screening participation, we developed a stochastic microsimulation model. With this model, 10,000 populations of 100,000 persons and their melanoma-related life histories were simulated separately for women and for men and calibrated to observed melanoma incidence. In a second step, life histories of melanoma were changed by an SCS.RESULTS: Compared with a nonscreening scenario (age-standardized mortality rate: 1.6 and 2.9 per 100,000 for women and men), a biennial SCS of the 35- to 85-year-old population with a participation probability of 20% for each screening-eligible individual and a test sensitivity of 80% reduced mortality by up to 0.7 and 1.4 deaths per 100,000 person-years for women and men, respectively, corresponding to a relative reduction of melanoma mortality by 45% in women and men.CONCLUSIONS: We developed a microsimulation model of melanoma mortality that can be used to evaluate the effectiveness of population-based skin cancer screening. The simulation provided plausible melanoma mortality predictions and is a tool for comparing different SCS scenarios. However, it does not provide estimates on total costs of SCS.

Resumo Limpo

ckground nationwid skin cancer screen scs implement germani aim improv earli detect melanoma order reduc melanoma mortal idea earli detect compel demonstr effect melanoma screen crucial sinc feasibl conduct epidemiolog studi investig impact factor screen interv target age group develop microsimul model abl predict melanoma mortal germani sever scs conditionsmethod use german cancer registri data popul data publish data melanoma progress screen particip develop stochast microsimul model model popul person melanomarel life histori simul separ women men calibr observ melanoma incid second step life histori melanoma chang scsresult compar nonscreen scenario agestandard mortal rate per women men biennial scs yearold popul particip probabl screeningelig individu test sensit reduc mortal death per personyear women men respect correspond relat reduct melanoma mortal women menconclus develop microsimul model melanoma mortal can use evalu effect populationbas skin cancer screen simul provid plausibl melanoma mortal predict tool compar differ scs scenario howev provid estim total cost scs

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