title: Life expectancy estimation with breast cancer: bias of the declining exponential function and an alternative to its use.
abstract: BACKGROUND
  Life expectancy gain (LEG) is an outcome measure commonly estimated with a declining exponential function in a Markov model. The accuracy of such estimates has not been objectively evaluated.
  
  
  OBJECTIVE
  To compare LEGs from declining exponential function estimates with those calculated from population data, using published screening mammography studies as examples.
  
  
  METHODS
  SEER-based population data are used to compare LEG calculation with declining exponential function estimation and empiric population data in a new model, the "nested" Markov.
  
  
  RESULTS
  Analyses of the LEG of mammographic screening based on the declining exponential function significantly overestimate LEGs for younger women and underestimate them for older women. Because of offsetting errors, all-age analyses paradoxically appear accurate.
  
  
  CONCLUSIONS
  Declining exponential function estimates of LEGs for chronic diseases with low mortality rates and long time horizons are liable to significant bias, especially with limited age cohorts.
authors.affiliation: Office of Health Promotion Research, Burlington, Vermont 05401-3444, USA. rholland@sover.net
authors.forename: R R
authors.initials: RR
authors.lastname: Holland
authors.forename: C A
authors.initials: CA
authors.lastname: Ellis
authors.forename: B M
authors.initials: BM
authors.lastname: Geller
authors.forename: D A
authors.initials: DA
authors.lastname: Plante
authors.forename: R H
authors.initials: RH
authors.lastname: Secker-Walker
mesh_terms: D000328:Adult; D000368:Aged; D015982:Bias; D001943:Breast Neoplasms / Q000401:mortality*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008327:Mammography; D008390:Markov Chains; D008875:Middle Aged; D015233:Models, Statistical; D018426:SEER Program; D016019:Survival Analysis