Development, calibration, and validation of a U.S. white male population-based simulation model of esophageal adenocarcinoma.
BACKGROUND
The incidence of esophageal adenocarcinoma (EAC) has risen rapidly in the U.S. and western world. The aim of the study was to begin the investigation of this rapid rise by developing, calibrating, and validating a mathematical disease simulation model of EAC using available epidemiologic data.


METHODS
The model represents the natural history of EAC, including the essential biologic health states from normal mucosa to detected cancer. Progression rates between health states were estimated via calibration, which identified distinct parameter sets producing model outputs that fit epidemiologic data; specifically, the prevalence of pre-cancerous lesions and EAC cancer incidence from the published literature and Surveillance, Epidemiology, and End Results (SEER) data. As an illustrative example of a clinical and policy application, the calibrated and validated model retrospectively analyzed the potential benefit of an aspirin chemoprevention program.


RESULTS
Model outcomes approximated calibration targets; results of the model's fit and validation are presented. Approximately 7,000 cases of EAC could have been prevented over a 30-year period if all white males started aspirin chemoprevention at age 40 in 1965.


CONCLUSIONS
The model serves as the foundation for future analyses to determine a cost-effective screening and management strategy to prevent EAC morbidity and mortality.
Hur
Chin
C
Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts, United States of America. chur@mgh-ita.org
Hayeck
Tristan J
TJ
Yeh
Jennifer M
JM
Richards
Ethan M
EM
Richards
Ethan B
EB
Spechler
Stuart J
SJ
Gazelle
G Scott
GS
Kong
Chung Yin
CY
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D000328:Adult; D000465:Algorithms; D016588:Anticarcinogenic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002138:Calibration; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D014481:United States; D044465:White People
D016588:Anticarcinogenic Agents; D001241:Aspirin