Publications by authors named "Veerle M H Coupe"
Introduction: After colorectal cancer (CRC) treatment, patients undergo five-year follow-up involving carcinoembryonic antigen (CEA) tests, imaging, and colonoscopies. This retrospective cohort study explores adherence to the CRC follow-up guideline in the Netherlands until 2021 and its association with treatment of recurrences with curative intent.
Methods: Stage II/III CRC patients with recurrent disease within 3 years after diagnosis were selected from the Netherlands Cancer Registry (n = 430).
Background: Cost-effectiveness analysis (CEA) of biomarkers is challenging due to the indirect impact on health outcomes and the lack of sufficient fit-for-purpose data. Hands-on guidance is lacking.
Objective: We aimed firstly to explore how CEAs in the context of three different types of biomarker applications have addressed these challenges, and secondly to develop recommendations for future CEAs.
Article Synopsis
- Colonoscopy surveillance for colorectal cancer (CRC) can be burdensome for patients, and stool tests might help reduce the need for colonoscopies by identifying individuals at higher risk.
- This study involved 3453 participants aged 50-75 who completed multiple stool tests and colonoscopies to assess the accuracy of these methods for detecting advanced neoplasia.
- Results indicated that stool-based strategies could effectively reduce colonoscopy frequency by 15%-41% while being safer and more cost-effective, particularly with fecal immunochemical tests (FITs), although multitarget stool DNA testing was found to be more expensive.
To optimize colorectal cancer (CRC) surveillance, accurate information on the risk of developing CRC from premalignant lesions is essential. However, directly observing this risk is challenging since precursor lesions, i.e.
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- The study evaluates strategies for colorectal cancer (CRC) surveillance in individuals with familial CRC risk, comparing different methods of colonoscopy and fecal testing.
- The optimal strategy identified is a combination of 10-yearly colonoscopy and 2-yearly FIT from ages 40 to 80, which enhances life quality and reduces costs.
- This approach not only prevents more CRC deaths but also significantly decreases the number of colonoscopies required compared to current guidelines.
Background: Current patient selection for adjuvant chemotherapy (ACT) after curative surgery for stage II colon cancer (CC) is suboptimal, causing overtreatment of high-risk patients and undertreatment of low-risk patients. Postoperative circulating tumor DNA (ctDNA) could improve patient selection for ACT.
Objectives: We conducted an early model-based evaluation of the (cost-)effectiveness of ctDNA-guided selection for ACT in stage II CC in the Netherlands to assess the conditions for cost-effective implementation.
Background: Minimally invasive liver surgery (MILS) is increasingly performed via the robot-assisted approach but may be associated with increased costs. This study is a post-hoc comparison of healthcare cost expenditure for robotic liver resection (RLR) and laparoscopic liver resection (LLR) in a high-volume center.
Methods: In-hospital and 30-day postoperative healthcare costs were calculated per patient in a retrospective series (October 2015-December 2022).
Unlabelled: Real-world data are necessitated to counsel patients about the risk for recurrent disease after curative treatment of colorectal cancer. This study provided a population-based overview of the epidemiology of recurrent disease in patients with surgically resected stage II/III colorectal cancer.Patients diagnosed with stage II/III primary colorectal cancer between July and December 2015 were selected from the Netherlands Cancer Registry (N = 3,762).
View Article and Find Full Text PDFBackground: The faecal immunochemical test (FIT) is widely employed for colorectal cancer screening. However, its sensitivity for advanced precursor lesions remains suboptimal. The multitarget FIT (mtFIT), measuring haemoglobin, calprotectin, and serpin family F member 2, has demonstrated enhanced sensitivity for advanced neoplasia, especially advanced adenomas, at equal specificity to FIT.
View Article and Find Full Text PDFObjective: We aimed to perform an early cost-effectiveness analysis of using a whole-genome sequencing-based tumor mutation burden (WGS-TMB), instead of programmed death-ligand 1 (PD-L1), for immunotherapy treatment selection in patients with non-squamous advanced/metastatic non-small cell lung cancer ineligible for targeted therapy, from a Dutch healthcare perspective.
Methods: A decision-model simulating individual patients with metastatic non-small cell lung cancer was used to evaluate diagnostic strategies to select first-line immunotherapy only or the immunotherapy plus chemotherapy combination. Treatment was selected using PD-L1 [A, current practice], WGS-TMB [B], and both PD-L1 and WGS-TMB [C].
Decision makers frequently face decisions about optimal resource allocation. A model-based economic evaluation can be used to guide decision makers in their choices by systematically evaluating the magnitude of expected health effects and costs of decision options and by making trade-offs explicit. We provide a guide to an iterative approach to the medical decision-making process by following a coherent framework, and outline the overarching iterative steps of model-based decision making.
View Article and Find Full Text PDFObjectives: To facilitate informed decision making on participating in colorectal cancer (CRC) screening, we assessed the benefit-harm balance of CRC screening for a wide range of subgroups over different time horizons.
Methods: The study combined incidence proportions of benefits and harms of (not) participating in CRC screening estimated by the Adenoma and Serrated pathway to CAncer microsimulation model, a preference eliciting survey, and benefit-harm balance modeling combining all outcomes to determine the net health benefit of CRC screening over 10, 20, and 30 years. Probability of net health benefit was estimated for 210 different subgroups based on age, sex, previous participation in CRC screening, and lifestyle.
Circulating tumor DNA (ctDNA) detection has multiple promising applications in oncology, but the road toward implementation in clinical practice is unclear. We aimed to support the implementation process by exploring potential future pathways of ctDNA testing. To do so, we studied four ctDNA-testing applications in two cancer types and elicited opinions from 30 ctDNA experts in the Netherlands.
View Article and Find Full Text PDFUnlabelled: Current morphologic features defining advanced adenomas (size ≥10 mm, high-grade dysplasia or ≥25% villous component) cannot optimally distinguish individuals at high risk or low risk of metachronous colorectal cancer (me-CRC), which may result in suboptimal surveillance. Certain DNA copy-number alterations (CNAs) are associated with adenoma-to-carcinoma progression. We aimed to evaluate whether these molecular features can better predict an individual's risk of me-CRC than the morphologic advanced adenoma features.
View Article and Find Full Text PDFBackground: Colorectal cancer (CRC) is among the most frequently diagnosed cancers. Approximately 20-30% of stage I-III CRC patients develop a recurrent tumour or metastases after curative surgical resection. Post-operative follow-up is indicated for the first five years after curative surgical resection.
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- Screening for colorectal cancer (CRC) significantly dropped during the COVID-19 pandemic, with a global deficit of 7.4 million screening tests in 2020, leading to a potential increase in CRC cases and deaths.
- Data from 29 countries were analyzed using four microsimulation models to assess the long-term effects of reduced screening participation and the potential benefits of catch-up screening strategies.
- Without catch-up efforts, an estimated 13,000 additional CRC cases and 7,900 deaths could occur by 2050; however, timely catch-up screening could prevent up to 85% of these outcomes.
Article Synopsis
- Scientists are finding new ways to test for colorectal cancer that are easier and less invasive than traditional methods.
- A group of experts updated the rules for how to evaluate these new tests to make sure they're effective.
- The new tests should be compared to the existing reliable tests and go through several phases of research to ensure they're safe and useful in real-world situations.
Article Synopsis
- Recent advancements in molecular diagnostics and drug treatments have shifted lung cancer treatment from traditional platinum-based chemotherapy to more personalized approaches like targeted therapies and immunotherapies, though these options are expensive.
- Traditional evaluation methods for treatment cost-effectiveness rely on randomized control trials (RCTs), which often don't reflect the real-world patient population who typically have worse prognoses.
- This study developed a patient-level microsimulation model based on real-world data in the Netherlands to assess personalized treatment strategies for advanced non-squamous NSCLC, validating it by comparing simulated outcomes with actual patient survival rates.
Circulating tumor DNA (ctDNA) is a promising new biomarker with multiple potential applications in cancer care. Estimating total cost of ctDNA testing is necessary for reimbursement and implementation, but challenging because of variations in workflow. We aimed to develop a micro-costing framework for consistent cost calculation of ctDNA testing.
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- * Patients were randomly assigned to either the intervention group (access to Oncokompas) or the control group (delay in access), with costs and health outcomes measured over three months.
- * Results indicated that Oncokompas had non-significantly lower costs but also appeared slightly less effective in improving quality-adjusted life years (QALYs), suggesting the need for further research on the economic value of eHealth in palliative care.
Longitudinal adherence to colorectal cancer (CRC) screening is reported using different summarizing measures, which hampers international comparison. We provide evidence to guide recommendations on which longitudinal adherence measure to report. Using adherence data over four stool-based CRC screening rounds in three countries, we calculated six summarizing adherence measures; adherence over all rounds, adherence per round, rescreening, full programme adherence (yes/no), regularity (never/inconsistent/consistent screenees) and number of times participated.
View Article and Find Full Text PDFPurpose: A large number of targeted treatment options for stage IV nonsquamous non-small-cell lung cancer with specific genetic aberrations in tumor DNA is available. It is therefore important to optimize diagnostic testing strategies, such that patients receive adequate personalized treatment that improves survival and quality of life. The aim of this study is to assess the efficacy (including diagnostic costs, turnaround time (TAT), unsuccessful tests, percentages of correct findings, therapeutic costs, and therapeutic effectiveness) of parallel next generation sequencing (NGS)-based versus sequential single-gene-based testing strategies routinely used in patients with metastasized non-small-cell lung cancer in the Netherlands.
View Article and Find Full Text PDFPurpose: Lynch syndrome-related colorectal cancer (CRC) risk substantially varies by mismatch repair (MMR) gene. We evaluated the health impact and cost-effectiveness of MMR gene-tailored colonoscopic surveillance.
Methods: We first estimated sex- and MMR gene-specific cumulative lifetime risk of first CRC without colonoscopic surveillance using an optimization algorithm.