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High rate of missed Barrett's esophagus when screening with forceps biopsies. Esophagus 2023; 20:143-149. [PMID: 35864425 PMCID: PMC9813185 DOI: 10.1007/s10388-022-00943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Screening for Barrett's esophagus (BE) with endoscopy plus forceps biopsy (FB) has poor compliance with the recommended Seattle protocol and fails to sample large areas of mucosa. This statistical modeling study estimates, for the first time, the actual frequency of missed BE cases by FB. METHODS Published, calibrated models in the literature were combined to calculate the age-specific prevalence of BE in white males with gastroesophageal reflux disease (GERD). We started with estimates of the prevalence of BE and GERD, and applied the relative risk for BE in patients with GERD based on the literature. This created estimates of the true prevalence of BE in white males with GERD by decade of life. The proportion of BE missed was calculated as the difference between the prevalence and the proportion with a positive screen. RESULTS The prevalence of BE in white males with GERD was 8.9%, 12.1%, 15.3%, 18.7% and 22.0% for the third through eighth decades of life. Even after assuming no false positives, missed cases of BE were about 50% when estimated for patients of ages 50 or 60 years, and over 60% for ages of 30, 40 or 70 years. Sensitivity analysis was done for all variables in the model calculations. For ages 50 and 60 years, this resulted in values from 30.3 to 57.3% and 36.4 to 60.9%. CONCLUSION Screening for BE with endoscopy and FB misses approximately 50% of BE cases. More sensitive methods of BE detection or better adherence to the Seattle protocol are needed.
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2
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Eluri S, Paterson A, Lauren BN, O’Donovan M, Bhandari P, di Pietro M, Lee M, Haidry R, Lovat L, Ragunath K, Hur C, Fitzgerald RC, Shaheen NJ. Utility and Cost-Effectiveness of a Nonendoscopic Approach to Barrett's Esophagus Surveillance After Endoscopic Therapy. Clin Gastroenterol Hepatol 2022; 20:e51-e63. [PMID: 33581357 PMCID: PMC8352994 DOI: 10.1016/j.cgh.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/28/2020] [Accepted: 02/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS A non-endoscopic approach to Barrett's esophagus (BE) surveillance after radiofrequency ablation (RFA) would offer a less invasive method for monitoring. We assessed the test characteristics and cost-effectiveness of the Cytosponge (Medtronic, Minneapolis, MN) in post-RFA patients. METHODS We performed a multicenter study of dysplastic BE patients after at least one round of RFA. A positive Cytosponge before endoscopy was defined as intestinal metaplasia (IM) on cytological assessment and/or TFF3 immunohistochemistry. Sensitivity, specificity, and receiver operator characteristic (ROC) curves were calculated. Multivariable regression was used to estimate the odds of a positive Cytosponge in BE. A microsimulation cost-effectiveness model was performed to assess outcomes of various surveillance strategies: endoscopy-only, Cytosponge-only, and alternating endoscopy/Cytosponge. RESULTS Of 234 patients, Cytosponge adequately sampled the distal esophagus in 175 (75%). Of the 142 with both endoscopic and histologic data, 19 (13%) had residual/recurrent BE. For detecting any residual Barrett's, Cytosponge had a sensitivity of 74%, specificity of 85%, accuracy of 84%, and ROC curve showed an area under the curve of 0.74. The adjusted odds of a positive Cytosponge in BE were 17.1 (95% CI, 5.2-55.9). Cytosponge-only surveillance dominated all the surveillance strategies, being both less costly and more effective. Cytosponge-only surveillance required <1/4th the endoscopies, resulting in only 0.69 additional EAC cases/1000 patients, and no increase in EAC deaths when compared to currently-practiced endoscopy-only surveillance. CONCLUSIONS A positive Cytosponge test was strongly associated with residual BE after ablation. While the assay needs further refinement in this context, it could serve as a cost-effective surveillance examination.
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Affiliation(s)
- Swathi Eluri
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Anna Paterson
- MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom
| | - Brianna N. Lauren
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center
| | - Maria O’Donovan
- MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Minyi Lee
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London Hospital, London, UK
| | - Laurence Lovat
- Division of Surgery and Interventional Science, University College London Hospital, London, UK
| | - Krish Ragunath
- Nottingham Digestive Diseases Center, NIHR Biomedical Research Centre, University of Nottingham, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center
| | | | - Nicholas J. Shaheen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
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Agha YH, Taleb A, Srinivasan S, Tofteland N, Salyers W. Screening for Barrett's Esophagus in Patients with Cirrhosis Using WATS 3D. Kans J Med 2021; 14:206-208. [PMID: 34367492 PMCID: PMC8343608 DOI: 10.17161/kjm.vol1415074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
The prevalence of gastroesophageal reflux disease and neoplastic progression in patients with cirrhosis is higher compared to patients without liver disease. The gold standard for screening for Barrett’s esophagus (BE) is esophagogastroduodenoscopy with forceps biopsy using the Seattle protocol. However, many physicians refrain from taking biopsies in cirrhotic patients and rely solely on endoscopic findings to avoid hemorrhagic complications secondary to variceal bleeding or coagulopathy. In this case series, we present seven cirrhotic patients at high risk of bleeding that underwent screening for BE by upper endoscopy using WATS3D with no postprocedural complications.
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Affiliation(s)
- Yasmine Hussein Agha
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ali Taleb
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Sachin Srinivasan
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Nathan Tofteland
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Division of Gastroenterology, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - William Salyers
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Division of Gastroenterology, University of Kansas School of Medicine-Wichita, Wichita, KS
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Singer ME, Smith MS. Wide Area Transepithelial Sampling with Computer-Assisted Analysis (WATS 3D) Is Cost-Effective in Barrett's Esophagus Screening. Dig Dis Sci 2021; 66:1572-1579. [PMID: 32578042 PMCID: PMC8053177 DOI: 10.1007/s10620-020-06412-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Wide area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D) is an adjunct to the standard random 4-quadrant forceps biopsies (FB, "Seattle protocol") that significantly increases the detection of Barrett's esophagus (BE) and associated neoplasia in patients undergoing screening or surveillance. AIMS To examine the cost-effectiveness of adding WATS3D to the Seattle protocol in screening patients for BE. METHODS A decision analytic model was used to compare the effectiveness and cost-effectiveness of two alternative BE screening strategies in chronic gastroesophageal reflux disease patients: FB with and without WATS3D. The reference case was a 60-year-old white male with gastroesophageal reflux disease (GERD). Effectiveness was measured by the number needed to screen to avert one cancer and one cancer-related death, and quality-adjusted life years (QALYs). Cost was measured in 2019 US$, and the incremental cost-effectiveness ratio (ICER) was measured in $/QALY using thresholds for cost-effectiveness of $100,000/QALY and $150,000/QALY. Cost was measured in 2019 US$. Cost and QALYs were discounted at 3% per year. RESULTS Between 320 and 337 people would need to be screened with WATS3D in addition to FB to avert one additional cancer, and 328-367 people to avert one cancer-related death. Screening with WATS3D costs an additional $1219 and produced an additional 0.017 QALYs, for an ICER of $71,395/QALY. All one-way sensitivity analyses resulted in ICERs under $84,000/QALY. CONCLUSIONS Screening for BE in 60-year-old white male GERD patients is more cost-effective when WATS3D is used adjunctively to the Seattle protocol than with the Seattle protocol alone.
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Affiliation(s)
- Mendel E. Singer
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Michael S. Smith
- Division of Gastroenterology and Hepatology, Mount Sinai West and Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, Ambulatory Care Center, 13th Floor, 440 W 114th St., New York, NY 10025 USA
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5
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Development of an Empirically Calibrated Model of Esophageal Squamous Cell Carcinoma in High-Risk Regions. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2741598. [PMID: 31240208 PMCID: PMC6556290 DOI: 10.1155/2019/2741598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/13/2019] [Indexed: 01/04/2023]
Abstract
Objective This study constructs, calibrates, and verifies a mathematical simulation model designed to project the natural history of ESCC and is intended to serve as a platform for testing the benefits and cost-effectiveness of primary and secondary ESCC prevention alternatives. Methods The mathematical model illustrates the natural history of ESCC as a sequence of transitions among health states, including the primary health states (e.g., normal mucosa, precancerous lesions, and undetected and detected cancer). Using established calibration approaches, the parameter sets related to progression rates between health states were optimized to lead the model outputs to match the observed data (specifically, the prevalence of precancerous lesions and incidence of ESCC from the published literature in Chinese high-risk regions). As illustrative examples of clinical and policy application, the calibrated and validated model retrospectively simulate the potential benefit of two reported ESCC screening programs. Results Nearly 1,000 good-fitting parameter sets were identified from 1,000,000 simulated sets. Model outcomes had sufficient calibration fit to the calibration targets. Additionally, the verification analyses showed reasonable external consistency between the model-predicted effectiveness of ESCC screening and the reported data from clinical trials. Conclusions This parameterized mathematical model offers a tool for future research investigating benefits, costs, and cost-effectiveness related to ESCC prevention and treatment.
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Hammer MM, Palazzo LL, Eckel AL, Barbosa EM, Kong CY. A Decision Analysis of Follow-up and Treatment Algorithms for Nonsolid Pulmonary Nodules. Radiology 2018; 290:506-513. [PMID: 30457486 DOI: 10.1148/radiol.2018180867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate management strategies and treatment options for patients with ground-glass nodules (GGNs) by using decision-analysis models. Materials and Methods A simulation was developed for 1 000 000 hypothetical patients with GGNs undergoing follow-up per the Lung Imaging Reporting and Data System (Lung-RADS) recommendations. The initial age range was 55-75 years (mean, 64 years). Nodules could grow and develop solid components over time. Clinically significant malignancy rates were calibrated to data from the National Lung Screening Trial. Annual versus 3-year-interval follow-up of Lung-RADS category 2 nodules was compared, and different treatment strategies were tested (stereotactic body radiation therapy, surgery, and no therapy). Results Overall, 2.3% (22 584 of 1 000 000) of nodules were clinically significant malignancies; 6.3% (62 559 of 1 000 000) of nodules were treated. Only 30% (18 668 of 62 559) of Lung-RADS category 4B or 4X nodules were clinically significant malignancies. The risk of clinically significant malignancy for persistent nonsolid nodules after baseline was higher than Lung-RADS estimates for categories 2 and 3 (3% vs <1% and 1%-2%, respectively). Overall survival (OS) at 10 years was 72% (527 827 of 737 306; 95% confidence interval [CI]: 71%, 72%) with annual follow-up and 71% (526 507 of 737 306; 95% CI: 71%, 72%) with 3-year-interval follow-up (P < .01). At 10 years, OS among patients whose nodules progressed to Lung-RADS category 4B or 4X was 80% after radiation therapy (49 945 of 62 559; 95% CI: 80%, 80%), 79% after surgery (49 139 of 62 559; 95% CI: 78%, 79%), and 74% after no therapy (46 512 of 62 559; 95% CI: 74%, 75%) (P < .01). Conclusion Simulation modeling suggests that the follow-up interval for evaluating ground-glass nodules can be increased from 1 year to 3 years with minimal change in outcomes. Stereotactic body radiation therapy demonstrated the best outcomes compared with lobectomy and with no therapy for nonsolid nodules. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Mark M Hammer
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Lauren L Palazzo
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Andrew L Eckel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Eduardo M Barbosa
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
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7
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Dahabreh IJ, Wong JB, Trikalinos TA. Validation and calibration of structural models that combine information from multiple sources. Expert Rev Pharmacoecon Outcomes Res 2017; 17:27-37. [PMID: 28043174 DOI: 10.1080/14737167.2017.1277143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mathematical models that attempt to capture structural relationships between their components and combine information from multiple sources are increasingly used in medicine. Areas covered: We provide an overview of methods for model validation and calibration and survey studies comparing alternative approaches. Expert commentary: Model validation entails a confrontation of models with data, background knowledge, and other models, and can inform judgments about model credibility. Calibration involves selecting parameter values to improve the agreement of model outputs with data. When the goal of modeling is quantitative inference on the effects of interventions or forecasting, calibration can be viewed as estimation. This view clarifies issues related to parameter identifiability and facilitates formal model validation and the examination of consistency among different sources of information. In contrast, when the goal of modeling is the generation of qualitative insights about the modeled phenomenon, calibration is a rather informal process for selecting inputs that result in model behavior that roughly reproduces select aspects of the modeled phenomenon and cannot be equated to an estimation procedure. Current empirical research on validation and calibration methods consists primarily of methodological appraisals or case-studies of alternative techniques and cannot address the numerous complex and multifaceted methodological decisions that modelers must make. Further research is needed on different approaches for developing and validating complex models that combine evidence from multiple sources.
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Affiliation(s)
- Issa J Dahabreh
- a Center for Evidence Synthesis in Health, School of Public Health , Brown University , Providence , RI , USA.,b Department of Health Services, Policy & Practice, School of Public Health , Brown University , Providence , RI , USA.,c Department of Epidemiology, School of Public Health , Brown University , Providence , RI , USA
| | - John B Wong
- d Division of Clinical Decision Making, Department of Medicine , Tufts Medical Center , Boston , MA , USA
| | - Thomas A Trikalinos
- a Center for Evidence Synthesis in Health, School of Public Health , Brown University , Providence , RI , USA.,b Department of Health Services, Policy & Practice, School of Public Health , Brown University , Providence , RI , USA
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8
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Pandharipande PV, Heberle C, Dowling EC, Kong CY, Tramontano A, Perzan KE, Brugge W, Hur C. Targeted screening of individuals at high risk for pancreatic cancer: results of a simulation model. Radiology 2015; 275:177-87. [PMID: 25393849 PMCID: PMC4372492 DOI: 10.1148/radiol.14141282] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify when, from the standpoint of relative risk, magnetic resonance (MR) imaging-based screening may be effective in patients with a known or suspected genetic predisposition to pancreatic cancer. MATERIALS AND METHODS The authors developed a Markov model of pancreatic ductal adenocarcinoma (PDAC). The model was calibrated to National Cancer Institute Surveillance, Epidemiology, and End Results registry data and informed by the literature. A hypothetical screening strategy was evaluated in which all population individuals underwent one-time MR imaging screening at age 50 years. Screening outcomes for individuals with an average risk for PDAC ("base case") were compared with those for individuals at an increased risk to assess for differential benefits in populations with a known or suspected genetic predisposition. Effects of varying key inputs, including MR imaging performance, surgical mortality, and screening age, were evaluated with a sensitivity analysis. RESULTS In the base case, screening resulted in a small number of cancer deaths averted (39 of 100 000 men, 38 of 100 000 women) and a net decrease in life expectancy (-3 days for men, -4 days for women), which was driven by unnecessary pancreatic surgeries associated with false-positive results. Life expectancy gains were achieved if an individual's risk for PDAC exceeded 2.4 (men) or 2.7 (women) times that of the general population. When relative risk increased further, for example to 30 times that of the general population, averted cancer deaths and life expectancy gains increased substantially (1219 of 100 000 men, life expectancy gain: 65 days; 1204 of 100 000 women, life expectancy gain: 71 days). In addition, results were sensitive to MR imaging specificity and the surgical mortality rate. CONCLUSION Although PDAC screening with MR imaging for the entire population is not effective, individuals with even modestly increased risk may benefit.
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Affiliation(s)
- Pari V. Pandharipande
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Curtis Heberle
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Emily C. Dowling
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Chung Yin Kong
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Angela Tramontano
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Katherine E. Perzan
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - William Brugge
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
| | - Chin Hur
- From the Massachusetts General Hospital Institute for Technology
Assessment (P.V.P., C.H., E.C.D., C.Y.K., A.T., K.E.P., C.H.), Department of
Radiology (P.V.P., C.H., E.C.D., C.Y.K., A.T.), and Department of General Medicine,
Gastrointestinal Unit (K.E.P., W.B., C.H.), Massachusetts General Hospital, 101
Merrimac St, 10th Floor, Boston, MA 02114; and Harvard Medical School, Boston,
Mass
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9
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Kong CY, Kroep S, Curtius K, Hazelton WD, Jeon J, Meza R, Heberle CR, Miller MC, Choi SE, Lansdorp-Vogelaar I, van Ballegooijen M, Feuer EJ, Inadomi JM, Hur C, Luebeck EG. Exploring the recent trend in esophageal adenocarcinoma incidence and mortality using comparative simulation modeling. Cancer Epidemiol Biomarkers Prev 2014; 23:997-1006. [PMID: 24692500 PMCID: PMC4048738 DOI: 10.1158/1055-9965.epi-13-1233] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The incidence of esophageal adenocarcinoma (EAC) has increased five-fold in the United States since 1975. The aim of our study was to estimate future U.S. EAC incidence and mortality and to shed light on the potential drivers in the disease process that are conduits for the dramatic increase in EAC incidence. METHODS A consortium of three research groups calibrated independent mathematical models to clinical and epidemiologic data including EAC incidence from the Surveillance, Epidemiology, and End Results (SEER 9) registry from 1975 to 2010. We then used a comparative modeling approach to project EAC incidence and mortality to year 2030. RESULTS Importantly, all three models identified birth cohort trends affecting cancer progression as a major driver of the observed increases in EAC incidence and mortality. All models predict that incidence and mortality rates will continue to increase until 2030 but with a plateauing trend for recent male cohorts. The predicted ranges of incidence and mortality rates (cases per 100,000 person years) in 2030 are 8.4 to 10.1 and 5.4 to 7.4, respectively, for males, and 1.3 to 1.8 and 0.9 to 1.2 for females. Estimates of cumulative cause-specific EAC deaths between both sexes for years 2011 to 2030 range between 142,300 and 186,298, almost double the number of deaths in the past 20 years. CONCLUSIONS Through comparative modeling, the projected increases in EAC cases and deaths represent a critical public health concern that warrants attention from cancer control planners to prepare potential interventions. IMPACT Quantifying this burden of disease will aid health policy makers to plan appropriate cancer control measures. Cancer Epidemiol Biomarkers Prev; 23(6); 997-1006. ©2014 AACR.
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Affiliation(s)
- Chung Yin Kong
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Sonja Kroep
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Kit Curtius
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - William D Hazelton
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Jihyoun Jeon
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Rafael Meza
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Curtis R Heberle
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Melecia C Miller
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Sung Eun Choi
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Marjolein van Ballegooijen
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Eric J Feuer
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - John M Inadomi
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Chin Hur
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Depart
| | - E Georg Luebeck
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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Choi SE, Perzan KE, Tramontano AC, Kong CY, Hur C. Statins and aspirin for chemoprevention in Barrett's esophagus: results of a cost-effectiveness analysis. Cancer Prev Res (Phila) 2013; 7:341-50. [PMID: 24380852 DOI: 10.1158/1940-6207.capr-13-0191-t] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Data suggest that aspirin, statins, or a combination of the two drugs may lower the progression of Barrett's esophagus to esophageal adenocarcinoma. However, aspirin is associated with potential complications such as gastrointestinal bleeding and hemorrhagic stroke, and statins are associated with myopathy. We developed a simulation disease model to study the effectiveness and cost effectiveness of aspirin and statin chemoprevention against esophageal adenocarcinoma. A decision analytic Markov model was constructed to compare four strategies for Barrett's esophagus management; all regimens included standard endoscopic surveillance regimens: (i) endoscopic surveillance alone, (ii) aspirin therapy, (iii) statin therapy, and (iv) combination therapy of aspirin and statin. Endpoints evaluated were life expectancy, quality-adjusted life years (QALY), costs, and incremental cost-effectiveness ratios (ICER). Sensitivity analysis was performed to determine the impact of model input uncertainty on results. Assuming an annual progression rate of 0.33% per year from Barrett's esophagus to esophageal adenocarcinoma, aspirin therapy was more effective and cost less than (dominated) endoscopic surveillance alone. When combination therapy was compared with aspirin therapy, the ICER was $158,000/QALY, which was above our willingness-to-pay threshold of $100,000/QALY. Statin therapy was dominated by combination therapy. When higher annual cancer progression rates were assumed in the model (0.5% per year), combination therapy was cost-effective compared with aspirin therapy, producing an ICER of $96,000/QALY. In conclusion, aspirin chemoprevention was both more effective and cost less than endoscopic surveillance alone. Combination therapy using both aspirin and statin is expensive but could be cost-effective in patients at higher risk of progression to esophageal adenocarcinoma.
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Affiliation(s)
- Sung Eun Choi
- Massachusetts General Hospital, 101 Merrimac Street, 10th Floor, Boston, MA 02114.
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11
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Hur C, Choi SE, Rubenstein JH, Kong CY, Nishioka NS, Provenzale DT, Inadomi JM. The cost effectiveness of radiofrequency ablation for Barrett's esophagus. Gastroenterology 2012; 143:567-575. [PMID: 22626608 PMCID: PMC3429791 DOI: 10.1053/j.gastro.2012.05.010] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/19/2012] [Accepted: 05/09/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Radiofrequency ablation (RFA) reduces the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE) with high-grade dysplasia (HGD), but its effects in patients without dysplasia are debatable. We analyzed the effectiveness and cost effectiveness of RFA for the management of BE. METHODS We constructed a decision analytic Markov model. We conducted separate analyses of hypothetical cohorts of patients with BE with dysplasia (HGD or low-grade [LGD]) and without dysplasia. In the analysis of the group with HGD, we compared results of initial RFA with endoscopic surveillance with surgery when cancer was detected. In analyzing the group with LGD or no dysplasia, we compared 3 strategies: endoscopic surveillance with surgery when cancer was detected (S1), endoscopic surveillance with RFA when HGD was detected (S2), and initial RFA followed by endoscopic surveillance (S3). RESULTS Among patients with HGD, initial RFA was more effective and less costly than endoscopic surveillance. Among patients with LGD, when S3 was compared with S2, the incremental cost-effectiveness ratio was $18,231/quality-adjusted life-year, assuming an annual rate of progression rate from LGD to EAC of 0.5%/year. For patients without dysplasia, S2 was more effective and less costly than S1. In a comparison of S3 with S2, the incremental cost-effectiveness ratios were $205,500, $124,796, and $118,338/quality-adjusted life-year using annual rates of progression of no dysplasia to EAC of 0.12%, 0.33%, or 0.5% per year, respectively. CONCLUSIONS By using updated data, initial RFA might not be cost effective for patients with BE without dysplasia, within the range of plausible rates of progression of BE to EAC, and be prohibitively expensive, from a policy perspective. RFA might be cost effective for confirmed and stable LGD. Initial RFA is more effective and less costly than endoscopic surveillance in HGD.
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Affiliation(s)
- Chin Hur
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Sung Eun Choi
- Institute for Technology Assessment, Massachusetts General Hospital, Boston MA
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor MI
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston MA,Harvard Medical School, Boston MA
| | - Norman S Nishioka
- Gastrointestinal Unit, Massachusetts General Hospital, Boston MA,Harvard Medical School, Boston MA
| | | | - John M Inadomi
- Division of Gastroenterology, University of Washington School of Medicine, Seattle WA
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12
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Kong CY, Nattinger KJ, Hayeck TJ, Omer ZB, Wang YC, Spechler SJ, McMahon PM, Gazelle GS, Hur C. The impact of obesity on the rise in esophageal adenocarcinoma incidence: estimates from a disease simulation model. Cancer Epidemiol Biomarkers Prev 2011; 20:2450-6. [PMID: 21930957 DOI: 10.1158/1055-9965.epi-11-0547] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The United States has experienced an alarming and unexplained increase in the incidence of esophageal adenocarcinoma (EAC) since the 1970s. A concurrent increase in obesity has led some to suggest a relationship between the two trends. We explore the extent of this relationship. METHODS Using a previously validated disease simulation model of white males in the United States, we estimated EAC incidence 1973 to 2005 given constant obesity prevalence and low population progression rates consistent with the early 1970s. Introducing only the observed, rising obesity prevalence, we calculated the incremental incidence caused by obesity. We compared these with EAC incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry to determine obesity's contribution to the rise therein. Incidences were converted to absolute numbers of cases using U.S. population data. RESULTS Using constant obesity prevalence, we projected a total of 30,555 EAC cases cumulatively over 1973 to 2005 and 1,151 in 2005 alone. Incorporating the observed obesity trend resulted in 35,767 cumulative EACs and 1,608 in 2005. Estimates derived from SEER data showed 111,223 cumulative and 7,173 cases in 2005. We conclude that the rise in obesity accounted for 6.5% of the increase in EAC cases that occurred from 1973 to 2005 and 7.6% in the year 2005. CONCLUSION Using published OR for EAC among obese individuals, we found that only a small percentage of the rise in EAC incidence is attributable to secular trends in obesity. IMPACT Other factors, alone and in combination, should be explored as causes of the EAC epidemic.
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Affiliation(s)
- Chung Yin Kong
- Institute for Technology Assessment, Harvard Medical School, Boston, MA 02114, USA
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13
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Hayeck TJ, Kong CY, Spechler SJ, Gazelle GS, Hur C. The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data. Dis Esophagus 2010; 23:451-7. [PMID: 20353441 PMCID: PMC2896446 DOI: 10.1111/j.1442-2050.2010.01054.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Barrett's esophagus (BE) is the precursor and the biggest risk factor for esophageal adenocarcinoma (EAC), the solid cancer with the fastest rising incidence in the US and western world. Current strategies to decrease morbidity and mortality from EAC have focused on identifying and surveying patients with BE using upper endoscopy. An accurate estimate of the number of patients with BE in the population is important to inform public health policy and to prioritize resources for potential screening and management programs. However, the true prevalence of BE is difficult to ascertain because the condition frequently is symptomatically silent, and the numerous clinical studies that have analyzed BE prevalence have produced a wide range of estimates. The aim of this study was to use a computer simulation disease model of EAC to determine the estimates for BE prevalence that best align with US Surveillance Epidemiology and End Results (SEER) cancer registry data. A previously developed mathematical model of EAC was modified to perform this analysis. The model consists of six health states: normal, gastroesophageal reflux disease (GERD), BE, undetected cancer, detected cancer, and death. Published literature regarding the transition rates between these states were used to provide boundaries. During the one million computer simulations that were performed, these transition rates were systematically varied, producing differing prevalences for the numerous health states. Two filters were sequentially applied to select out superior simulations that were most consistent with clinical data. First, among these million simulations, the 1000 that best reproduced SEER cancer incidence data were selected. Next, of those 1000 best simulations, the 100 with an overall calculated BE to Detected Cancer rates closest to published estimates were selected. Finally, the prevalence of BE in the final set of best 100 simulations was analyzed. We present histogram data depicting BE prevalences for all one million simulations, the 1000 simulations that best approximate SEER data, and the final set of 100 simulations. Using the best 100 simulations, we estimate the prevalence of BE to be 5.6% (5.49-5.70%). Using our model, an estimated prevalence for BE in the general population of 5.6% (5.49-5.70%) accurately predicts incidence rates for EAC reported to the US SEER cancer registry. Future clinical studies are needed to confirm our estimate.
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Affiliation(s)
- Tristan J. Hayeck
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA USA, Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA USA
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA USA, Harvard Medical School, Boston, MA USA
| | | | - G. Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA USA, Harvard Medical School, Boston, MA USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA USA, Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA USA, Harvard Medical School, Boston, MA USA,Correspondence: Chin Hur, MD, MPH, Massachusetts General Hospital, 101 Merrimac Street, 10 Floor, Boston, MA 02114
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