Recalibrating an Established Microsimulation Model to Capture Trends and Projections of Colorectal Cancer Incidence and Mortality.

BackgroundChanging colorectal cancer (CRC) incidence rates, including recent increases for people younger than 50 y, need to be considered in planning for future cancer control and screening initiatives. Reliable estimates of the impact of changing CRC trends on the National Bowel Cancer Screening Program (NBCSP) are essential for programmatic planning in Australia. An existing microsimulation model of CRC, Policy1-Bowel, was updated to reproduce Australian CRC trends data and provide updated projections of CRC- and screening-related outcomes to inform clinical practice guidelines for the prevention of CRC.MethodsPolicy1-Bowel was recalibrated to reproduce statistical age-period-cohort model trends and projections of CRC incidence for 1995-2045 in the absence of the NBCSP as well as published data on CRC incidence trends, stage distribution, and survival in 1995-2020 in Australia. The recalibrated Policy1-Bowel predictions were validated by comparison with published Australian CRC mortality trends for 1995-2015 and statistical projections to 2040. Metamodels were developed to aid the calibration process and significantly reduce the computational burden.ResultsPolicy1-Bowel was recalibrated, and best-fit parameter sets were identified for lesion incidence, CRC stage progression rates, detection rates, and survival rates by age, sex, bowel location, cancer stage, and birth year. The recalibrated model was validated and successfully reproduced observed CRC mortality rates for 1995-2015 and statistical projections for 2016-2030.ConclusionThe recalibrated Policy1-Bowel model captures significant additional detail on the future incidence and mortality burden of CRC in Australia. This is particularly relevant as younger cohorts with higher CRC incidence rates approach screening ages to inform decision making for these groups. The metamodeling approach allows fast recalibration and makes regular updates to incorporate new evidence feasible.HighlightsIn Australia, colorectal cancer incidence rates are increasing for people younger than 50 y but decreasing for people older than 50 y, and colorectal cancer survival is improving as new treatment technologies emerge.To evaluate the future health and economic impact of screening and inform policy, modeling must include detailed trends and projections of colorectal cancer incidence, mortality, and diagnosis stage.We used novel techniques including integrative age-period cohort projections and metamodel calibration to update Policy1-Bowel, a detailed microsimulation of colorectal cancer and screening in Australia.