Using a partially observable Markov chain model to assess colonoscopy screening strategies - A cohort study

Colorectal cancer (CRC) is notoriously hard to combat for its high incidence and mortality rates. However, with improved screening technology and better understanding of disease pathways, CRC is more likely to be detected at early stage and thus more likely to be cured. Among the available screening methods, colonoscopy is most commonly used in the U.S. because of its capability of visualizing the entire colon and removing the polyps it detected. The current national guideline for colonoscopy screening recommends an observation-based screening strategy. Nevertheless, there is scant research studying the cost-effectiveness of the recommended observation-based strategy and its variants. In this paper, we describe a partially observable Markov chain (POMC) model which allows us to assess the cost-effectiveness of both fixed-interval and observation-based colonoscopy screening strategies. In our model, we consider detailed adenomatous polyp states and estimate state transition probabilities based on longitudinal clinical data from a specific population cohort. We conduct a comprehensive numerical study which investigates several key factors in screening strategy design, including screening frequency, initial screening age, screening end age, and screening compliance rate. We also conduct sensitivity analyses on the cost and quality of life parameters. Our numerical result demonstrates the usability of our model in assessing colonoscopy screening strategies with consideration of partial observation of true health states. This research facilitates future design of better colonoscopy screening strategies.