Mortality modeling of early detection programs

Biometrics. 2008 Jun;64(2):386-95. doi: 10.1111/j.1541-0420.2007.00893.x. Epub 2007 Aug 28.

Abstract

Consider a group of subjects who are offered an opportunity to receive a sequence of periodic special examinations for the purpose of diagnosing a chronic disease earlier relative to usual care. The mortality for the early detection group is to be compared with a group receiving usual care. Benefit is reflected in a potential reduction in mortality. This article develops a general probability model that can be used to predict cumulative mortality for each of these groups. The elements of the model assume (i) a four-state progressive disease model in which a subject may be in a disease-free state (or a disease state that cannot be detected), preclinical disease state (capable of being diagnosed by a special exam), clinical state (diagnosis by usual care), and a death state; (ii) age-dependent transitions into the states; (iii) age-dependent examination sensitivity; (iv) age-dependent sojourn time in each state; and (v) the distribution of disease stages on diagnosis conditional on modality of detection. The model may be used to (i) compare mortality rates for different screening schedules; (ii) explore potential benefit of subpopulations; and (iii) compare relative reductions in disease-specific mortality due to advances and dissemination of both treatment and early detection screening programs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Biometry / methods
  • Chronic Disease / mortality*
  • Chronic Disease / prevention & control*
  • Computer Simulation
  • Humans
  • Models, Biological*
  • Models, Statistical
  • Population Surveillance / methods*
  • Proportional Hazards Models*
  • Survival Analysis*
  • Survival Rate*