Integrating Periodic Check-Ups in Health State Transition Models without Disrupting Progression

I am trying to build a model where a patient can transition through various health states: starting as uninfected, potentially becoming infected, and eventually developing a chronic disease. I would like to incorporate a medical check-up every five years to monitor the patient’s health status. However, if I create a specific check-up branch, this risks interrupting the patient’s health state progression during that cycle, unless I incorporate the entire health state tree within the check-up branch, which complicates the model.

Is there a way to introduce an intermediate branch for the check-up that allows the patient to return to their previous health state within the same cycle? For instance, if the patient is uninfected and the check-up day arrives, they would enter the check-up branch and then return to the “uninfected” category after the check-up to continue progressing normally without changing the stage ?

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    I believe I understand your dilemma.

    What I have seen in several CRC models is handling both screening and disease progression in the same transition subtrees for each state.

    1. Start at the health state.
    2. Create screen/no screen branches.
    3. Build disease progression events off the no screen arm and create a clone master for those events.
    4. Create events to cover the results of the test in the screening arm.
    5. At the end points for at least some of the screening branches, attach a copy of the disease progression clone, so progression occurs the same way with/without screening.

    There will likely be some changes in events/outcomes/etc. based on screening results, so those might not use the cloned disease progression steps. Create appropriate post-screening events for those branches.

    Of course there will be variation based on the model/health issue, but the handling of both screening events and disease progression events will need to be covered in the transition subtree for each health state.

    Please reach out to support@treeage.com should you want to discuss your model in more detail.

    Andrew

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  • Thank you very much, Andrew, for your help. I’ll implement this strategy right away.

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