Biomedical subjects

G Draisma

Publications and source records attributed to G Draisma.

4 recordsLinked to original sources

PubMed2006

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands.

In mammography screening with double reading, different strategies can be used when the readers give discordant recommendations for referral. We investigated whether the results of the Dutch breast cancer screening programme can be optimised by replacing the standard referral strategy by consensus. Twenty-six screening radiologists independently and blinded to outcome read a test set consisting of previous screening mammograms of 250 cases (screen-detected and interval cancers) and 250 controls. Their referral recommendations were paired and, in case of discrepancy, re-read according to three referral strategies: (1) decision by one of the readers; (2) arbitration by a third reader; (3) referral if both readers agree (consensus). Data allowed studying other referral strategies, including referral if any reader suggests, as well. Double reading with referral if any reader suggests resulted in a 1.03 times higher sensitivity (76.6%) and a 1.31 times higher referral rate (1.26%) than double reading with consensus. To estimate the cost-effectiveness, the outcomes were used in a microsimulation model. Even if double reading with referral if any reader suggests results in four times as high referral rates and an accompanying increase of biopsies or other invasive procedures, the cost-effectiveness of 4,190 Euros per life-year gained may well be in the range of acceptable cost-effectiveness for Dutch health care programmes.

Breast Neoplasms↗

PubMed2004

Trends in the usage of adjuvant systemic therapy for breast cancer in the Netherlands and its effect on mortality.

Adjuvant systemic therapy was introduced in the Netherlands as a breast cancer treatment in the early 1980s. In this paper, we describe the trends in the usage of adjuvant systemic treatment in the period 1975-1997 in the Netherlands. The main aim of our study was to assess the effects of adjuvant tamoxifen and polychemotherapy on breast cancer mortality, compared to the effects of the mammography screening programme. The computer simulation model MIcrosimulation SCreening ANalysis, which simulates demography, natural history of breast cancer and screening effects, was used to estimate the effects. Use of adjuvant therapy increased over time, but since 1990 it remained rather stable. Nowadays, adjuvant therapy is given to 88% of node-positive patients aged 50-69 years, while less than 10% of node-negative patients receive any kind of adjuvant treatment. Adjuvant treatment is given independent of the mode of detection (adjusted by nodal status and size). We predict that the reduction in breast cancer mortality due to adjuvant therapy is 7% in women aged 55-74 years, while the reduction due to screening, which was first implemented in women aged 50-69 years in 1990-97, will be 28-30% in 2007. In conclusion, although adjuvant systemic therapy can reduce breast cancer mortality rates, it is anticipated to be less than the mortality reduction caused by mammography screening.

Age Distribution↗

PubMed2003

MISCAN: estimating lead-time and over-detection by simulation.

OBJECTIVE: To estimate the mean lead-time and rate of over-detection associated with screening for prostate cancer with prostate-specific antigen. METHODS: Simulation models, fitted to the results of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer, were used to predict the mean lead-time and over-detection rate in population-based screening programmes. RESULTS: The mean lead-time is estimated to be 11-12 years and over-detection to occur in half the cases found by population screening. The estimates are compared with published estimates. CONCLUSIONS: The effect of lead-time and over-detection on the balance of positive and negative consequences of screening cannot be neglected.

Aged↗

PubMed1999

Breeding biology of muscovy duck (Cairina moschata) under natural incubation: the use of the weibull function and a beta-binomial model to predict nest hatchability

In this paper we tested the Weibull function and beta-binomial distribution to analyse and predict nest hatchability, using empirical data on hatchability in Muscovy duck (Cairina moschata) eggs under natural incubation (932 successfully incubated nests and 11 822 eggs). The estimated parameters of the Weibull function and beta-binomial model were compared with the logistic regression analysis. The maximum likelihood estimation of the parameters was used to quantify simultaneously the influence of the nesting behaviour and the duration of the reproduction cycle on hatchability. The estimated parameters showed that the hatchability was not affected in natural dump nests, but in artificial dump nests and in nests with non-term eggs the hatchability was reduced by 10 and 25%, respectively. Similar results were obtained using logistic regression. Both models provided a satisfactory description of the observed data set, but the beta-binomial model proved to have more parameters with practical and biological meaningful interpretations, because this model is able to quantify and incorporate the unexplained variation in a single parameter theta (which is a variance measure). Copyright 1999 Academic Press.

Journal Article↗