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@ARTICLE{Cheng:212517,
      author       = {C.-Y. Cheng$^*$ and S. Calderazzo$^*$ and C. Schramm and M.
                      Schlander$^*$},
      title        = {{M}odeling the {N}atural {H}istory and {S}creening
                      {E}ffects of {C}olorectal {C}ancer {U}sing {B}oth {A}denoma
                      and {S}errated {N}eoplasia {P}athways: {T}he {D}evelopment,
                      {C}alibration, and {V}alidation of a {D}iscrete {E}vent
                      {S}imulation {M}odel.},
      journal      = {Medical decision making policy $\&$ practice},
      volume       = {8},
      number       = {1},
      issn         = {2381-4683},
      address      = {London},
      publisher    = {Sage Publishing},
      reportid     = {DKFZ-2023-00202},
      pages        = {238146832211457 -},
      year         = {2023},
      note         = {#EA:C100#LA:C100#},
      abstract     = {Background. Existing colorectal cancer (CRC) screening
                      models mostly focus on the adenoma pathway of CRC
                      development, overlooking the serrated neoplasia pathway,
                      which might result in overly optimistic screening
                      predictions. In addition, Bayesian inference methods have
                      not been widely used for model calibration. We aimed to
                      develop a CRC screening model accounting for both pathways,
                      calibrate it with approximate Bayesian computation (ABC)
                      methods, and validate it with large CRC screening trials.
                      Methods. A discrete event simulation (DES) of the CRC
                      natural history (DECAS) was constructed using the adenoma
                      and serrated pathways in R software. The model simulates
                      CRC-related events in a specific birth cohort through
                      various natural history states. Calibration took advantage
                      of 74 prevalence data points from the German screening
                      colonoscopy program of 5.2 million average-risk participants
                      using an ABC method. CRC incidence outputs from DECAS were
                      validated with the German national cancer registry data;
                      screening effects were validated using 17-y data from the UK
                      Flexible Sigmoidoscopy Screening sigmoidoscopy trial and a
                      German screening colonoscopy cohort study. Results. The
                      Bayesian calibration rendered 1,000 sets of posterior
                      parameter samples. With the calibrated parameters, the
                      observed age- and sex-specific CRC prevalences from the
                      German registries were within the $95\%$ DECAS-predicted
                      intervals. Regarding screening effects, DECAS predicted a
                      $41\%$ $(95\%$ intervals $30\%-51\%)$ and $62\%$ $(95\%$
                      intervals $55\%-68\%)$ reduction in 17-y cumulative CRC
                      mortality for a single screening sigmoidoscopy and
                      colonoscopy, respectively, falling within $95\%$ confidence
                      intervals reported in the 2 clinical studies used for
                      validation. Conclusions. We presented DECAS, the first
                      Bayesian-calibrated DES model for CRC natural history and
                      screening, accounting for 2 CRC tumorigenesis pathways. The
                      validated model can serve as a valid tool to evaluate the
                      (cost-)effectiveness of CRC screening strategies.This
                      article presents a new discrete event simulation model,
                      DECAS, which models both adenoma-carcinoma and serrated
                      neoplasia pathways for colorectal cancer (CRC) development
                      and CRC screening effects.DECAS is calibrated based on a
                      Bayesian inference method using the data from German
                      screening colonoscopy program, which consists of more than 5
                      million first-time average-risk participants aged 55 years
                      and older in 2003 to 2014.DECAS is flexible for evaluating
                      various CRC screening strategies and can differentiate
                      screening effects in different parts of the colon.DECAS is
                      validated with large screening sigmoidoscopy and colonoscopy
                      clinical study data and can be further used to evaluate the
                      (cost-)effectiveness of German colorectal cancer screening
                      strategies.},
      keywords     = {bayesian calibration (Other) / colorectal cancer (Other) /
                      discrete event simulation (Other) / screening (Other) /
                      serrated polyps (Other)},
      cin          = {C100 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)C100-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36698854},
      pmc          = {pmc:PMC9869210},
      doi          = {10.1177/23814683221145701},
      url          = {https://inrepo02.dkfz.de/record/212517},
}