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Table 1 Input Parameters for Mammography Simulation Model

From: A simulation model approach to analysis of the business case for eliminating health care disparities

 

Base Model Parameter

Range Used in Sensitivity Analysis

Source(s)

State Transition Probabilities

   

Annual Incidence of Cancer

.003

 

[64–67]

Probability of Annual, Biennial, and Sporadic Mammogram Patterns

HEDIS 70%

- Annual = 0.197

- Biennial = 0.395

- Sporadic = 0.270

- None = 0.138

 

[59–63], authors' calculations

 

HEDIS 80%

- Annual = 0.242

- Biennial = 0.483

- Sporadic = 0.182

- None = 0.093

  

Increase in Probability of Mammography Following False Positive

.10 increase relative to probability in absence of false positive

 

[50]

Probability of Cancer Found, Given Screening Pattern

- Annual = .003

- Biennial = .003

- Sporadic = .005

- None = .008

 

[68, 69]

Distribution of Stage at Diagnosis with (W/O) Mammogram

Annual

- In Situ = 0.13

- Stage I = 0.41

- Stage II = 0.37

- Stage III = 0.07

- Stage IV = 0.02

 

[70–76]

 

Biennial

- In Situ = 0.13 (0.04)

- Stage I = 0.41 (0.32)

- Stage II = 0.37 (0.43)

- Stage III = 0.07 (0.13)

- Stage IV = 0.02 (0.08)

In Situ = 0.04 - 0.21

Stage I = 0.32 - 0.57

Stage II = 0.16 - 0.43

Stage III = 0.04 - 0.13

Stage IV = 0.02 - 0.08

 
 

Sporadic

- In Situ = 0.17 (0.04)

- Stage I = 0.29 (0.32)

- Stage II = 0.40 (0.43)

- Stage III = 0.09 (0.13)

- Stage IV = 0.05 (0.08)

  
 

None

- In Situ = (0.04)

- Stage I = (0.32)

- Stage II = (0.43)

- Stage III = (0.13)

- Stage IV = (0.08)

  

Probability of Remission in Year of Diagnosis, Given Stage at Diagnosis

Stage I = 97.5%

Stage II = 94.0%

Stage III = 81.0%

Stage IV = 66.0%

 

[73, 77]

Probability of Death from Other Causes

.01

 

[78, 79]

Probability of Continued Remission vs. Recurrent Disease, Given Stage at Diagnosis and Initial Remission

Stage I = 0.975

Stage II = 0.94

Stage III = 0.81

Stage IV = 0.66

 

[73, 77]

Probability of Death, Given Recurrent or Progressive Disease

0.79

 

[73, 77]

State Values

   

Utility of Well, Non-Cancer States

1.0

 

[80–86]

Utility of Newly Diagnosed Cancer, by Stage at Diagnosis

Stage I = 0.90

Stage II = 0.85

Stage III = 0.81

Stage IV = 0.81

Stage I = 0.80 - 0.98

Stage II = 0.80 - 0.98

Stage III = 0.80 - 0.98

Stage IV = 0.80 - 0.98

[80–86]

Utility of Undergoing Treatment, by Stage at Diagnosis

Stage I = -0.10

Stage II = -0.20

Stage III = -0.25

Stage IV = -0.25

 

[80–86]

Utility of Progressive Disease

0.40

0.30 - 0.69

[80–86]

Probability of Employment - no Cancer

1.00

 

Arbitrary - simulation assumes women employed

Probability of Employment in Year of Cancer Diagnosis, by Treatment Stage

In Situ = 0.86

Stage I = 0.70

Stage II = 0.60

Stage III = 0.50

Stage IV = 0.40

 

[88–94]

Probability of Employment in Year of Cancer Diagnosis, by Remission Stage

Stage I = 0.94

Stage II = 0.88

Stage III = 0.81

Stage IV = 0.75

 

[88–94]

Probability of Employment - Progressive Disease

0.56

 

[88–94]

Other Values

   

Costs of Initial Treatment, by Stage at Diagnosis

Stage I = $ 22,488.00

Stage II = $ 27,213.00

Stage III = $ 29,220.00

Stage IV = $ 31,476.00

 

[48]

Costs of Treatment - Recurrent or Progressive Disease

$ 33,000.00

 

[48]

Cost of Mammogram

$ 81.86

 

Federal Register, 2007

Cost of Followup after False Postive Test

$533

 

[106]

Hourly Wage for Time Missed from Work

$ 21.31

 

Department of Labor, May 2007 [46]