A0661
Title: Assessing the benefits and burdens of preventive interventions with semi-competing risks data
Authors: Yi Xiong - University at Buffalo (United States) [presenting]
Kwun Chuen Gary Chan - University of Washington (United States)
Malka Gorfine - Tel Aviv University (Israel)
Li Hsu - Fred Hutchinson Cancer Research Center (United States)
Abstract: Cancer screening has been widely recognized as an effective strategy for preventing the disease. Despite its effectiveness, determining when to start screening is complicated because starting too early increases the number of screenings over a lifetime and thus costs, but starting too late may cause cancer that could have been prevented. Therefore, to make an informed recommendation on the age to start screening, it is necessary to conduct a cost-effectiveness analysis to assess the gain in life years relative to the cost of screenings. As more large-scale observational studies become accessible, there is growing interest in evaluating cost-effectiveness based on empirical evidence. A unified measure is provided for evaluating cost-effectiveness and causal analysis for the continuous intervention of screening initiation age under the multi-state modeling with semi-competing risks, which allows gaining insights on benefit and cost at each stage of cancer progression. The method is justified theoretically and numerically using both simulation and the CRC data from the Women's Health Initiative observational study. The analysis reveals that initiating screening at the age of 50 years yields the highest quality-adjusted life years with an acceptable incremental cost-effectiveness ratio compared to no screening, providing real-world evidence in support of screening recommendations for colorectal cancer.
