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Sánchez-Romero LM, Li Y, Zavala-Arciniega L, Gallegos-Carrillo K, Thrasher JF, Meza R, Levy DT. The potential impact of removing a ban on electronic nicotine delivery systems using the Mexico smoking and vaping model (SAVM). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.28.24306511. [PMID: 38746147 PMCID: PMC11092684 DOI: 10.1101/2024.04.28.24306511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Objective To develop the Mexico Smoking and Vaping Model (Mexico SAVM) to estimate cigarette and electronic nicotine delivery systems (ENDS) prevalence and the public health impact of legalizing ENDS use. Methods SAVM, a cohort-based discrete-time simulation model, compares two scenarios. The ENDS-Restricted Scenario estimates smoking prevalence and associated mortality outcomes under the current policy of an ENDS ban, using Mexico-specific population projections, death rates, life expectancy, and smoking and e-cigarette prevalence. The ENDS-Unrestricted Scenario projects smoking and vaping prevalence under a hypothetical scenario where ENDS use is allowed. The impact of legalizing ENDS use is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the ENDS-Restricted and Unrestricted scenarios. Results Compared to a national ENDS ban, The Mexico SAVM projects that legalizing ENDS use could decrease smoking prevalence by 40.1% in males and 30.9% in females by 2049 compared to continuing the national ENDS ban. This reduction in prevalence would save 2.9 (2.5 males and 0.4 females) million life-years and avert almost 106 (91.0 males and 15.5 females) thousand deaths between 2025 and 2049. Public health gains decline by 43% to 59,748 SVADs averted when the switching rate is reduced by half and by 24.3% (92,806 SVADs averted) with a 25% ENDS risk level from that of cigarettes but increased by 24.3% (121,375 SVADs averted) with the 5% ENDS risk. Conclusions Mexico SAVM suggests that greater access to ENDS and a more permissive ENDS regulation, simultaneous with strong cigarette policies, would reduce smoking prevalence and decrease smoking-related mortality. The unanticipated effects of an ENDS ban merit closer scrutiny, with further consideration of how specific ENDS restrictions may maximize public health benefits.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
| | - Luis Zavala-Arciniega
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Katia Gallegos-Carrillo
- Epidemiology and Health Services Research Unit, Morelos, Mexican Institute of Social Security, Mexico
- Evaluation and Surveys Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States of America
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Canada
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC. United States of America
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Sánchez-Romero LM, Liber AC, Li Y, Yuan Z, Tam J, Travis N, Jeon J, Issabakhsh M, Meza R, Levy DT. The smoking and vaping model, A user-friendly model for examining the country-specific impact of nicotine VAPING product use: application to Germany. BMC Public Health 2023; 23:2299. [PMID: 37990171 PMCID: PMC10662637 DOI: 10.1186/s12889-023-17152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Simulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs. METHODS SAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM's adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data. RESULTS Assuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period. CONCLUSIONS SAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA.
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Columbia, Canada
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
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Jeon J, Inoue-Choi M, Mok Y, McNeel TS, Tam J, Freedman ND, Meza R. Mortality Relative Risks by Smoking, Race/Ethnicity, and Education. Am J Prev Med 2023; 64:S53-S62. [PMID: 36775754 PMCID: PMC11186465 DOI: 10.1016/j.amepre.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The impact of cigarette smoking on mortality is well studied, with estimates of the relative mortality risks for the overall population widely available. However, age-specific mortality estimates for different sociodemographic groups in the U.S. are lacking. METHODS Using the 1987-2018 National Health Interview Survey Linked Mortality Files through 2019, all-cause mortality relative risks (RRs) were estimated for current smokers or recent quitters and long-term quitters compared with those for never smokers. Stratified Cox proportional hazards regression models were used to estimate RRs by age, gender, race/ethnicity, and educational attainment. RRs were also assessed for current smokers or recent quitters by smoking intensity and for long-term quitters by years since quitting. The analysis was conducted in 2021-2022. RESULTS All-cause mortality RRs among current smokers or recent quitters were generally highest for non-Hispanic White individuals than for never smokers, followed by non-Hispanic Black individuals, and were lowest for Hispanic individuals. RRs varied greatly by educational attainment; generally, higher-education groups had greater RRs associated with smoking than lower-education groups. Conversely, the RRs by years since quitting among long-term quitters did not show clear differences across race/ethnicity and education groups. Age-specific RR patterns varied greatly across racial/ethnic and education groups as well as by gender. CONCLUSIONS Age-specific all-cause mortality rates associated with smoking vary considerably by sociodemographic factors. Among high-education groups, lower underlying mortality rates for never smokers result in correspondingly high RR estimates for current smoking. These estimates can be incorporated in modeling analyses to assess tobacco control interventions' impact on smoking-related health disparities between different sociodemographic groups.
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Affiliation(s)
- Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Maki Inoue-Choi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Yoonseo Mok
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | | | - Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Méndez D, Le TTT, Warner KE. Monitoring the Increase in the U.S. Smoking Cessation Rate and its Implication for Future Smoking Prevalence. Nicotine Tob Res 2022; 24:1727-1731. [PMID: 35486922 DOI: 10.1093/ntr/ntac115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We calculate the U.S. adult smoking cessation rate for 2014-2019, compare it to the historical trend, and estimate the implication for future smoking prevalence. METHODS We repeated an earlier analysis, which examined the cessation rate from 1990-2014, extending the period to 2019. Employing National Health Interview Survey (NHIS) and National Survey on Drug Use and Health (NSDUH) data, we estimated the adult cessation rate in six-year intervals, using weighted non-linear least squares. We then employed a meta-regression model to test whether the cessation rate has increased beyond expectation. We used cessation rate estimates and smoking initiation rate estimates to project smoking prevalence in 2030 and eventual steady-state prevalence. RESULTS The annual cessation rate increased 29% using NHIS data (from 4.2% in 2008-2013 to 5.4% in 2014-2019) and 33% with NSDUH data (4.2% to 5.6%). The cessation rate increase accounts for 60% of a smoking prevalence decline in the most recent period exceeding the 1990-2013 predicted trend. The remaining 40% owes to declining smoking initiation. With current initiation and cessation rates, smoking prevalence should fall to 8.3% in 2030 and eventually reach a steady state of 3.53%. CONCLUSIONS The smoking cessation rate continued to increase during 2014-2019. NHIS and NSDUH results are practically identical. The larger share (60%) of the smoking prevalence decrease, beyond expectation, attributable to the increased cessation rate is encouraging since the positive health effects of cessation occur much sooner than those derived from declining initiation. IMPLICATIONS The smoking cessation rate in the U.S. continues to increase, accelerating the decline in smoking prevalence. This increase suggests that the Healthy People 2030 goal of 5% adult smoking prevalence, while ambitious, is attainable. Our findings can be used in simulation and statistical models that aim to predict future prevalence and population health effects due to smoking under various scenarios.
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Affiliation(s)
- David Méndez
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Thuy T T Le
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
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Russell LB, Volpp KG, Kwong PL, Cosgriff BS, Harhay MO, Zhu J, Halpern SD. Cost-Effectiveness of Four Financial Incentive Programs for Smoking Cessation. Ann Am Thorac Soc 2021; 18:1997-2006. [PMID: 33979562 PMCID: PMC8641815 DOI: 10.1513/annalsats.202012-1473oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: A trial of four financial incentive programs, conducted at CVS Caremark, a large employer, documented their effectiveness in promoting sustained abstinence from smoking, but their cost-effectiveness is unknown, and the significant up-front cost of the incentives is a deterrent to their adoption. Objectives: To determine the cost-effectiveness of these incentives from the healthcare sector and employer perspectives. Methods: This study examines a decision model built with trial data, supplemented by data from the literature. Life-expectancy gains for quitters were projected on the basis of U.S. life tables. The two individual-oriented programs paid $800 for smoking cessation at 6 months; one required participants to deposit $150 at baseline. Payments in the two group-oriented programs varied with the group's success; again, one required participants to deposit $150. Results: Life-years, quality-adjusted life-years (QALYs), costs (2012 dollars), and cost-effectiveness ratios are described. From the healthcare sector perspective, costs ranged from $3,200 per life-year ($2,500 per QALY) for the competitive deposit program, compared with usual care, to $6,500 per life-year ($5,100 per QALY) for the individual reward program. From the employer perspective, costs ranged from $256,600 per life-year gained for the individual deposit program to $1,711,100 per life-year gained for the individual reward program; the cost per QALY ranged from $65,300 for the competitive deposit program to $128,800 for the individual reward program. Cost-effectiveness from the employer perspective improved with longer decision horizons. Including future medical costs reduced cost-effectiveness from both perspectives. Conclusions: Four financial incentive programs that paid smokers to quit are very cost-effective from the healthcare sector perspective. They are more expensive from the employer perspective but may be cost-effective for employers with longer decision horizons.
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Affiliation(s)
- Louise B. Russell
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Pui L. Kwong
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | | | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy
- Center for Health Incentives and Behavioral Economics
| | - Scott D. Halpern
- Department of Medical Ethics and Health Policy
- Department of Medicine, and
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics
- Leonard Davis Institute of Health Economics, and
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Cadham CJ, Cao P, Jayasekera J, Taylor KL, Levy DT, Jeon J, Elkin EB, Foley KL, Joseph A, Kong CY, Minnix JA, Rigotti NA, Toll BA, Zeliadt SB, Meza R, Mandelblatt J. Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study. J Natl Cancer Inst 2021; 113:1065-1073. [PMID: 33484569 PMCID: PMC8502465 DOI: 10.1093/jnci/djab002] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/02/2020] [Accepted: 01/04/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. METHODS We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. RESULTS Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. CONCLUSION All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.
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Affiliation(s)
- Christopher J Cadham
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - Pianpian Cao
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jinani Jayasekera
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - Kathryn L Taylor
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - David T Levy
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elena B Elkin
- Department of Health Policy and Management at Columbia University Mailman School of Public Health, New York, NY, USA
| | - Kristie L Foley
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anne Joseph
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Chung Yin Kong
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer A Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy A Rigotti
- Department of Medicine and Mongan Institute, Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Benjamin A Toll
- Department of Public Health Sciences and Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Steven B Zeliadt
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jeanne Mandelblatt
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
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Hammer MM, Eckel AL, Palazzo LL, Kong CY. Cost-Effectiveness of Treatment Thresholds for Subsolid Pulmonary Nodules in CT Lung Cancer Screening. Radiology 2021; 300:586-593. [PMID: 34128723 DOI: 10.1148/radiol.2021204418] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Guidelines such as the Lung CT Screening Reporting and Data System (Lung-RADS) are available for determining when subsolid nodules should be treated within lung cancer screening programs, but they are based on expert opinion. Purpose To evaluate the cost-effectiveness of varying treatment thresholds for subsolid nodules within a lung cancer screening setting by using a simulation model. Materials and Methods A previously developed model simulated 10 million current and former smokers undergoing CT lung cancer screening who were assumed to have a ground-glass nodule (GGN) at baseline. Nodules were allowed to grow and to develop solid components over time according to a monthly cycle and lifetime horizon. Management strategies generated by varying treatment thresholds, including the solid component size and use of the Brock risk calculator, were tested. For each strategy, average U.S. costs and quality-adjusted life years (QALYs) gained per patient were computed, and the incremental cost-effectiveness ratios (ICERs) of those on the efficient frontier were calculated. One-way and probabilistic sensitivity analyses of results were performed by varying several relevant parameters, such as treatment costs or malignancy growth rates. Results Variants of the Lung-RADS guidelines that did not treat pure GGNs were cost-effective. Strategies based on the Brock risk calculator did not reach the efficient frontier. The strategy with the highest QALYs under a willingness-to-pay threshold of $100 000 per QALY included no treatment of GGNs and a threshold of 4-mm solid component size for treatment of subsolid nodules. This strategy yielded an ICER of $52 993 per QALY (95% CI: 44 407, 64 372). Probabilistic sensitivity analysis showed this was the optimal strategy under a range of parameter variations. Conclusion Treatment of pure ground-glass nodules was not cost-effective. Strategies that use modifications of the Lung CT Screening Reporting and Data System guidelines were cost-effective for treating part-solid nodules; an optimal threshold of 4 mm for the solid component yielded the most quality-adjusted life years. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Mark M Hammer
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Andrew L Eckel
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Lauren L Palazzo
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology (Thoracic Division), Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Institute of Technology Assessment, Massachusetts General Hospital, Boston, Mass (A.L.E.); Department of Statistical Science, Duke University, Durham, NC (L.L.P.); and Icahn School of Medicine at Mount Sinai, New York, NY (C.Y.K.)
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Levy DT, Sánchez-Romero LM, Travis N, Yuan Z, Li Y, Skolnick S, Jeon J, Tam J, Meza R. US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4876. [PMID: 34063672 PMCID: PMC8124578 DOI: 10.3390/ijerph18094876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model. Upon validating the model before NVPs were more widely used, we project a No-NVP (i.e., in the absence of NVPs) while controlling for the impact of cigarette-oriented policies. The net impact of NVPs on smoking prevalence is inferred by comparing the projected No-NVP smoking trends to corresponding trends from two US national surveys. Using the TUS-CPS estimates for the period 2012-2018, we estimate that adult smoking prevalence declined in relative terms by 9.7% (95% CI: 7.5-11.7%) for males and 10.7% (95% CI: 9.1-13.0%) for females. Compared to NHIS, smoking prevalence declined by 10.7% (95% CI: 6.8-14.6%) for males and 11.3% (95% CI: 7.4-15.6%) for females. These impacts were confined mainly to ages 18-44. Vaping-related reductions in smoking prevalence were projected to avert nearly 0.4 million SADs between 2012 and 2052. Our analysis indicates that NVP use is associated with substantial reductions in US smoking prevalence among younger adults.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jamie Tam
- Department of Health Policy and Management, Yale University School of Public Health, Hartford, CT 06520, USA;
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
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Levy DT, Cummings KM, Heckman BW, Li Y, Yuan Z, Smith TT, Meza R. The Public Health Gains Had Cigarette Companies Chosen to Sell Very Low Nicotine Cigarettes. Nicotine Tob Res 2021; 23:438-446. [PMID: 32710538 DOI: 10.1093/ntr/ntaa128] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/01/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The U.S. Food and Drug Administration (FDA) has proposed lowering the nicotine content of cigarettes to a minimally addictive level to increase smoking cessation and reduce initiation. This study has two aims: (1) to determine when cigarette manufacturers had the technical capability to reduce cigarette nicotine content and (2) to estimate the lost public health benefits of implementing a standard in 1965, 1975, or 1985. METHODS To determine the technical capability of cigarette companies, we reviewed public patents and internal cigarette company business records using the Truth Tobacco Industry Documents. To evaluate the impact of a very low nicotine content cigarette (VLNC) standard on smoking attributable deaths (SADs) and life-years lost (LYLs), we applied a validated (CISNET) model that uses past smoking data, along with estimates of the potential impact of VLNCs derived from expert elicitation. RESULTS Cigarette manufacturers recognized that cigarettes were deadly and addictive before 1964. Manufacturers have had the technical capability to lower cigarette nicotine content for decades. Our model projected that a standard implemented in 1965 could have averted 21 million SADs (54% reduction) and 272 million LYLs (64% reduction) from 1965 to 2064, a standard implemented in 1975 could have averted 18.9 million SADs and 245.4 million LYLs from 1975 to 2074, and a standard implemented in 1985 could have averted 16.3 million SADs and 211.5 million LYLs from 1985 to 2084. CONCLUSIONS Millions of premature deaths could have been averted if companies had only sold VLNCs decades ago. FDA should act immediately to implement a VLNC standard. IMPLICATIONS Prior research has shown that a mandated reduction in the nicotine content of cigarettes could reduce the prevalence of smoking and improve public health. Here we report that cigarette manufacturers have had the ability to voluntarily implement such a standard for decades. We use a well-validated model to demonstrate that millions of smoking attributable deaths and life-years lost would have been averted if the industry had implemented such a standard.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Charleston, SC
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Charleston, SC
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, Cancer Epidemiology and Prevention Program, Rogel Cancer Center, University of Michigan, Ann Arbor, MI
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10
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Levy DT, Tam J, Sanchez-Romero LM, Li Y, Yuan Z, Jeon J, Meza R. Public health implications of vaping in the USA: the smoking and vaping simulation model. Popul Health Metr 2021; 19:19. [PMID: 33865410 PMCID: PMC8052705 DOI: 10.1186/s12963-021-00250-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/31/2021] [Indexed: 12/05/2022] Open
Abstract
Background Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), a user-friendly model which estimates the public health implications of NVPs in the USA. Methods SAVM adopts a cohort approach. We derive public health implications by comparing smoking- and NVP-attributable deaths and life-years lost under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former, and never smoking rates via smoking initiation and cessation rates, with their respective mortality rates. The NVP Scenario allows for smoking- and NVP-specific mortality rates, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. After validating the model against recent US survey data, we present the base model with extensive sensitivity analyses. Results The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 1.8 million premature smoking- and vaping-attributable deaths avoided and 38.9 million life-years gained between 2013 and 2060. When the NVP relative risk is set to 5%, the results are sensitive to the level of switching and smoking cessation rates and to a lesser extent smoking initiation rates. When the NVP relative risk is raised to 40%, the public health gains in terms of averted deaths and LYL are reduced by 42% in the base case, and the results become much more sensitive to variations in the base case parameters. Discussion Policymakers, researchers, and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources. In developing new simulation models involving NVPs, it will be important to conduct extensive sensitivity analysis and continually update and validate with new data. Conclusion The SAVM indicates the potential benefits of NVP use. However, given the uncertainty surrounding model parameters, extensive sensitivity analysis becomes particularly important. Supplementary Information The online version contains supplementary material available at 10.1186/s12963-021-00250-7.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Luz María Sanchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St, NW, Suite 4100, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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11
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Chang JT, Meza R, Levy DT, Arenberg D, Jeon J. Prediction of COPD risk accounting for time-varying smoking exposures. PLoS One 2021; 16:e0248535. [PMID: 33690706 PMCID: PMC7946316 DOI: 10.1371/journal.pone.0248535] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022] Open
Abstract
RATIONALE Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. Studies have primarily assessed the relationship between smoking on COPD risk focusing on summary measures, like smoking status. OBJECTIVE Develop a COPD risk prediction model incorporating individual time-varying smoking exposures. METHODS The Nurses' Health Study (N = 86,711) and the Health Professionals Follow-up Study (N = 39,817) data was used to develop a COPD risk prediction model. Data was randomly split in 50-50 samples for model building and validation. Cox regression with time-varying covariates was used to assess the association between smoking duration, intensity and year-since-quit and self-reported COPD diagnosis incidence. We evaluated the model calibration as well as discriminatory accuracy via the Area Under the receiver operating characteristic Curve (AUC). We computed 6-year risk of COPD incidence given various individual smoking scenarios. RESULTS Smoking duration, year-since-quit (if former smokers), sex, and interaction of sex and smoking duration are significantly associated with the incidence of diagnosed COPD. The model that incorporated time-varying smoking variables yielded higher AUCs compared to models using only pack-years. The AUCs for the model were 0.80 (95% CI: 0.74-0.86) and 0.73 (95% CI: 0.70-0.77) for males and females, respectively. CONCLUSIONS Utilizing detailed smoking pattern information, the model predicts COPD risk with better accuracy than models based on only smoking summary measures. It might serve as a tool for early detection programs by identifying individuals at high-risk for COPD.
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Affiliation(s)
- Joanne T. Chang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - David T. Levy
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington D.C., DC, United States of America
| | - Douglas Arenberg
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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12
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Tam J, Taylor GMJ, Zivin K, Warner KE, Meza R. Modeling smoking-attributable mortality among adults with major depression in the United States. Prev Med 2020; 140:106241. [PMID: 32860820 PMCID: PMC7680404 DOI: 10.1016/j.ypmed.2020.106241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/14/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
Tobacco-related health disparities disproportionately affect smokers with major depression (MD). Although tobacco simulation models have been applied to general populations, to date they have not considered populations with a comorbid mental health condition. We developed and calibrated a simulation model of smoking and MD comorbidity for the US adult population using the 2005-2018 National Surveys on Drug Use and Health. We use this model to evaluate trends in smoking prevalence, smoking-attributable mortality and life-years lost among adults with MD, and changes in smoking prevalence by mental health status from 2018 to 2060. The model integrates known interaction effects between smoking initiation and cessation, and MD onset and recurrence. We show that from 2018 to 2060, smoking prevalence will continue declining among those with current MD. In the absence of intervention, people with MD will be increasingly disproportionately affected by smoking compared to the general population; our model shows that the smoking prevalence ratio between those with current MD and those without a history of MD increases from 1.54 to 2.42 for men and from 1.81 to 2.73 for women during this time period. From 2018 to 2060, approximately 484,000 smoking-attributable deaths will occur among adults with current MD, leading to 11.3 million life-years lost. Ambitious tobacco control efforts could alter this trajectory. With aggressive public health efforts, up to 264,000 of those premature deaths could be avoided, translating into 7.5 million life years gained. This model can compare the relative health gains across different intervention strategies for smokers with MD.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States.
| | - Gemma M J Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Somerset, Claverton Down Bath BA2 7AY, United Kingdom.
| | - Kara Zivin
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Psychiatry, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States; Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Cancer Epidemiology and Prevention Program, University of Michigan Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States.
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13
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Hammer MM, Palazzo LL, Paquette A, Eckel AL, Jacobson FL, Barbosa EM, Kong CY. Cost-Effectiveness of Follow-Up for Subsolid Pulmonary Nodules in High-Risk Patients. J Thorac Oncol 2020; 15:1298-1305. [DOI: 10.1016/j.jtho.2020.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 12/01/2022]
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14
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Criss SD, Cao P, Bastani M, Ten Haaf K, Chen Y, Sheehan DF, Blom EF, Toumazis I, Jeon J, de Koning HJ, Plevritis SK, Meza R, Kong CY. Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study. Ann Intern Med 2019; 171:796-804. [PMID: 31683314 DOI: 10.7326/m19-0322] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recommendations vary regarding the maximum age at which to stop lung cancer screening: 80 years according to the U.S. Preventive Services Task Force (USPSTF), 77 years according to the Centers for Medicare & Medicaid Services (CMS), and 74 years according to the National Lung Screening Trial (NLST). OBJECTIVE To compare the cost-effectiveness of different stopping ages for lung cancer screening. DESIGN By using shared inputs for smoking behavior, costs, and quality of life, 4 independently developed microsimulation models evaluated the health and cost outcomes of annual lung cancer screening with low-dose computed tomography (LDCT). DATA SOURCES The NLST; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER (Surveillance, Epidemiology, and End Results) program; Nurses' Health Study and Health Professionals Follow-up Study; and U.S. Smoking History Generator. TARGET POPULATION Current, former, and never-smokers aged 45 years from the 1960 U.S. birth cohort. TIME HORIZON 45 years. PERSPECTIVE Health care sector. INTERVENTION Annual LDCT according to NLST, CMS, and USPSTF criteria. OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). RESULTS OF BASE-CASE ANALYSIS The 4 models showed that the NLST, CMS, and USPSTF screening strategies were cost-effective, with ICERs averaging $49 200, $68 600, and $96 700 per QALY, respectively. Increasing the age at which to stop screening resulted in a greater reduction in mortality but also led to higher costs and overdiagnosis rates. RESULTS OF SENSITIVITY ANALYSIS Probabilistic sensitivity analysis showed that the NLST and CMS strategies had higher probabilities of being cost-effective (98% and 77%, respectively) than the USPSTF strategy (52%). LIMITATION Scenarios assumed 100% screening adherence, and models extrapolated beyond clinical trial data. CONCLUSION All 3 sets of lung cancer screening criteria represent cost-effective programs. Despite underlying uncertainty, the NLST and CMS screening strategies have high probabilities of being cost-effective. PRIMARY FUNDING SOURCE CISNET (Cancer Intervention and Surveillance Modeling Network) Lung Group, National Cancer Institute.
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Affiliation(s)
- Steven D Criss
- Massachusetts General Hospital, Boston, Massachusetts (S.D.C., Y.C.)
| | - Pianpian Cao
- University of Michigan, Ann Arbor, Michigan (P.C., J.J., R.M.)
| | - Mehrad Bastani
- Stanford University School of Medicine, Stanford, California (M.B., I.T., S.K.P.)
| | - Kevin Ten Haaf
- Erasmus University Medical Center, Rotterdam, the Netherlands (K.T., E.F.B., H.J.D.)
| | - Yufan Chen
- Massachusetts General Hospital, Boston, Massachusetts (S.D.C., Y.C.)
| | - Deirdre F Sheehan
- Massachusetts General Hospital, Boston, Massachusetts, and Broad Institute, Cambridge, Massachusetts (D.F.S.)
| | - Erik F Blom
- Erasmus University Medical Center, Rotterdam, the Netherlands (K.T., E.F.B., H.J.D.)
| | - Iakovos Toumazis
- Stanford University School of Medicine, Stanford, California (M.B., I.T., S.K.P.)
| | - Jihyoun Jeon
- University of Michigan, Ann Arbor, Michigan (P.C., J.J., R.M.)
| | - Harry J de Koning
- Erasmus University Medical Center, Rotterdam, the Netherlands (K.T., E.F.B., H.J.D.)
| | - Sylvia K Plevritis
- Stanford University School of Medicine, Stanford, California (M.B., I.T., S.K.P.)
| | - Rafael Meza
- University of Michigan, Ann Arbor, Michigan (P.C., J.J., R.M.)
| | - Chung Yin Kong
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (C.Y.K.)
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15
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Cost-effectiveness of lung MRI in lung cancer screening. Eur Radiol 2019; 30:1738-1746. [DOI: 10.1007/s00330-019-06453-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/05/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022]
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16
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Tan KS, Eguchi T, Adusumilli PS. Reporting net survival in populations: a sensitivity analysis in lung cancer demonstrates the differential implications of reporting relative survival and cause-specific survival. Clin Epidemiol 2019; 11:781-792. [PMID: 31564983 PMCID: PMC6730547 DOI: 10.2147/clep.s210894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background Net survival is commonly quantified as relative survival (observed survival among lung cancer patients versus expected survival among the general population) and cause-specific survival (lung cancer–specific survival among lung cancer patients). These approaches have drastically different assumptions; hence, failure to distinguish between them results in significant implications for study findings. We quantified the differences between relative and cause-specific survival when reporting net survival of patients with non-small cell lung cancer (NSCLC). Methods Cases of NSCLC diagnosed between 2004 and 2014 were extracted from the Surveillance, Epidemiology, and End Results database. The net survival of each stage-by-age stratum was expressed as cause-specific survival (Kaplan-Meier approach) and relative survival (Ederer II approach); percentage-point (pp) differences between the survival estimates were quantified up to 10 years postdiagnosis. Results Analyses included 263,894 cases. Cause-specific survival estimates were higher than relative survival estimates across all strata. Although the differences were negligible at 1 year postdiagnosis, they increased with increasing years of follow-up, up to 9.3 pp at 10 years (eg, aged 60–74 with stage I disease: 53.0% vs 43.7%). Differences in survival estimates between the methods also increased by increasing age groups (eg, at 10 years postdiagnosis: 5.1 pp for ages 18–44, 8.8 pp for ages 45–59, and 9.3 pp for ages 60–74) but decreased drastically for those aged ≥75 (3.1 pp). Conclusion Relative survival and cause-specific survival are not interchangeable. The type of survival estimate used in cancer studies should be specified, particularly for long-term survival.
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Affiliation(s)
- Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA
| | - Takashi Eguchi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Prasad S Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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17
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Forjaz de Lacerda G, Howlader N, Mariotto AB. Differences in Cancer Survival with Relative versus Cause-Specific Approaches: An Update Using More Accurate Life Tables. Cancer Epidemiol Biomarkers Prev 2019; 28:1544-1551. [PMID: 31221717 DOI: 10.1158/1055-9965.epi-19-0125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/23/2019] [Accepted: 06/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We investigated differences in net cancer survival (survival observed if the only possible cause of death was the cancer under study) estimated using new approaches for relative survival (RS) and cause-specific survival (CSS). METHODS We used SEER data for patients diagnosed in 2000 to 2013, followed-up through December 31, 2014. For RS, we used new life tables accounting for geography and socio-economic status. For CSS, we used the SEER cause of death algorithm for attributing cancer-specific death. Estimates were compared by site, age, stage, race, and time since diagnosis. RESULTS Differences between 5-year RS and CSS were generally small. RS was always higher in screen-detectable cancers, for example, female breast (89.2% vs. 87.8%) and prostate (98.5% vs. 93.7%) cancers; differences increased with age or time since diagnosis. CSS was usually higher in the remaining cancer sites, particularly those related to specific risk factors, for example, cervix (70.9% vs. 68.3%) and liver (20.7% vs. 17.1%) cancers. For most cancer sites, the gap between estimates was smaller with more advanced stage.Conclusion: RS is the preferred approach to report cancer survival from registry data because cause of death may be inaccurate, particularly for older patients and long-term survivors as comorbidities increase challenges in determining cause of death. However, CSS proved to be more reliable in patients diagnosed with localized disease or cancers related to specific risk factors as general population life tables may not capture other causes of mortality. IMPACT Different approaches for net survival estimation should be considered depending on cancer under study.
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Affiliation(s)
- Gonçalo Forjaz de Lacerda
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland. .,Azores Cancer Registry, Azores Oncological Centre, Portugal
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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18
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Yamaguchi T, Nishiura H. Predicting the Epidemiological Dynamics of Lung Cancer in Japan. J Clin Med 2019; 8:jcm8030326. [PMID: 30857126 PMCID: PMC6463119 DOI: 10.3390/jcm8030326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/19/2019] [Accepted: 03/05/2019] [Indexed: 12/17/2022] Open
Abstract
While the prevalence of smoking has steadily declined over time, the absolute numbers of lung cancer cases and deaths have continued to increase in Japan. We employed a simple mathematical model that describes the relationship between demographic dynamics and smoking prevalence to predict future epidemiological trends of lung cancer by age and sex. Never-smokers, smokers, and ex-smokers were assumed to experience different hazard of lung cancer, and the model was parameterized using data from 2014 and before, as learning data, and a future forecast was obtained from 2015 onwards. The maximum numbers of lung cancer cases and deaths in men will be 76,978 (95% confidence interval (CI): 76,630⁻77,253) and 63,284 (95% CI: 62,991⁻63507) in 2024, while those in women will be 42,838 (95% CI: 42,601⁻43,095) and 32,267 (95% CI: 32,063⁻32,460) in 2035 and 2036, respectively. Afterwards, the absolute numbers of cases and deaths are predicted to decrease monotonically. Our compartmental modeling approach is well suited to predicting lung cancer in Japan with dynamic ageing and drastic decline in smoking prevalence. The predicted burden is useful for anticipating demands for diagnosis, treatment, and care in the healthcare sector.
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Affiliation(s)
- Takayuki Yamaguchi
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan.
- CREST, Japan Science and Technology Agency, Honcho 4-1-8, Kawaguchi, Saitama 332-0012, Japan.
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Jeon J, Holford TR, Levy DT, Feuer EJ, Cao P, Tam J, Clarke L, Clarke J, Kong CY, Meza R. Smoking and Lung Cancer Mortality in the United States From 2015 to 2065: A Comparative Modeling Approach. Ann Intern Med 2018; 169:684-693. [PMID: 30304504 PMCID: PMC6242740 DOI: 10.7326/m18-1250] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Tobacco control efforts implemented in the United States since the 1960s have led to considerable reductions in smoking and smoking-related diseases, including lung cancer. OBJECTIVE To project reductions in tobacco use and lung cancer mortality from 2015 to 2065 due to existing tobacco control efforts. DESIGN Comparative modeling approach using 4 simulation models of the natural history of lung cancer that explicitly relate temporal smoking patterns to lung cancer rates. SETTING U.S. population, 1964 to 2065. PARTICIPANTS Adults aged 30 to 84 years. MEASUREMENTS Models were developed using U.S. data on smoking (1964 to 2015) and lung cancer mortality (1969 to 2010). Each model projected lung cancer mortality by smoking status under the assumption that current decreases in smoking would continue into the future (status quo trends). Sensitivity analyses examined optimistic and pessimistic scenarios. RESULTS Under the assumption of continued decreases in smoking, age-adjusted lung cancer mortality was projected to decrease by 79% between 2015 and 2065. Concomitantly, and despite the expected growth, aging, and longer life expectancy of the U.S. population, the annual number of lung cancer deaths was projected to decrease from 135 000 to 50 000 (63% reduction). However, 4.4 million deaths from lung cancer are still projected to occur in the United States from 2015 to 2065, with about 20 million adults aged 30 to 84 years continuing to smoke in 2065. LIMITATION Projections assumed no changes to tobacco control efforts in the future and did not explicitly consider the potential effect of lung cancer screening. CONCLUSION Tobacco control efforts implemented since the 1960s will continue to reduce lung cancer rates well into the next half-century. Additional prevention and cessation efforts will be required to sustain and expand these gains to further reduce the lung cancer burden in the United States. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Jihyoun Jeon
- University of Michigan, Ann Arbor, Michigan (J.J., P.C., J.T., R.M.)
| | | | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC (D.T.L.)
| | - Eric J Feuer
- National Cancer Institute, Bethesda, Maryland (E.J.F.)
| | - Pianpian Cao
- University of Michigan, Ann Arbor, Michigan (J.J., P.C., J.T., R.M.)
| | - Jamie Tam
- University of Michigan, Ann Arbor, Michigan (J.J., P.C., J.T., R.M.)
| | - Lauren Clarke
- Cornerstone Systems Northwest, Lynden, Washington (L.C., J.C.)
| | - John Clarke
- Cornerstone Systems Northwest, Lynden, Washington (L.C., J.C.)
| | - Chung Yin Kong
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (C.Y.K.)
| | - Rafael Meza
- University of Michigan, Ann Arbor, Michigan (J.J., P.C., J.T., R.M.)
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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: 15] [Impact Index Per Article: 2.5] [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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21
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Affiliation(s)
- William C Black
- From the Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756
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22
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Han SS, Ten Haaf K, Hazelton WD, Jeon J, Meza R, Kong CY, Feuer EJ, de Koning HJ, Plevritis SK. Re: Think before you leap. Int J Cancer 2018; 142:1507-1509. [PMID: 29194597 DOI: 10.1002/ijc.31183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/14/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Summer S Han
- Department of Medicine, Stanford University, Palo Alto, CA.,Department of Radiology, Stanford University, Palo Alto, CA
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - William D Hazelton
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Chung Yin Kong
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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23
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Reddy KP, Kong CY, Hyle EP, Baggett TP, Huang M, Parker RA, Paltiel AD, Losina E, Weinstein MC, Freedberg KA, Walensky RP. Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States. JAMA Intern Med 2017; 177:1613-1621. [PMID: 28975270 PMCID: PMC5675744 DOI: 10.1001/jamainternmed.2017.4349] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/05/2017] [Indexed: 12/19/2022]
Abstract
Importance Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer. Objective To project cumulative lung cancer mortality by smoking exposure among PLWH in care. Design Using a validated microsimulation model of HIV, we applied standard demographic data and recent HIV/AIDS epidemiology statistics with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light). We stratified reported mortality rates attributable to lung cancer and other non-AIDS-related causes by smoking exposure and accounted for an HIV-conferred independent risk of lung cancer. Lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5. In sensitivity analyses, we accounted for nonadherence to antiretroviral therapy (ART) and for a range of HIV-conferred risks of death from lung cancer and from other non-AIDS-related diseases (eg, cardiovascular disease). Main Outcomes and Measures Cumulative lung cancer mortality by age 80 years (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths, accounting for nonadherence to ART. Results Among 40-year-old men with HIV, estimated cumulative lung cancer mortality for heavy, moderate, and light smokers who continued to smoke was 28.9%, 23.0%, and 18.8%, respectively; for those who quit smoking at age 40 years, it was 7.9%, 6.1%, and 4.3%; and for never smokers, it was 1.6%. Among women, the corresponding mortality for current smokers was 27.8%, 20.9%, and 16.6%; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%. ART-adherent individuals who continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, depending on sex and smoking intensity. Due to greater AIDS-related mortality risks, individuals with incomplete ART adherence had higher overall mortality but lower lung cancer mortality. Applying model projections to the approximately 644 200 PLWH aged 20 to 64 in care in the United States, 59 900 (9.3%) are expected to die from lung cancer if smoking habits do not change. Conclusions and Relevance Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.
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Affiliation(s)
- Krishna P. Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Chung Yin Kong
- Harvard Medical School, Boston, Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Travis P. Baggett
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Mingshu Huang
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Biostatistics Center, Massachusetts General Hospital, Boston
| | - Robert A. Parker
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Biostatistics Center, Massachusetts General Hospital, Boston
| | | | - Elena Losina
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Milton C. Weinstein
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
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24
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Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, Holford TR, Yuan Z, Luo Y, O'Connor RJ, Niaura R, Abrams DB. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tob Control 2017; 27:18-25. [PMID: 28970328 PMCID: PMC5801653 DOI: 10.1136/tobaccocontrol-2017-053759] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/11/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
Abstract
Introduction US tobacco control policies to reduce cigarette use have been effective, but their impact has been relatively slow. This study considers a strategy of switching cigarette smokers to e-cigarette use (‘vaping’) in the USA to accelerate tobacco control progress. Methods A Status Quo Scenario, developed to project smoking rates and health outcomes in the absence of vaping, is compared with Substitution models, whereby cigarette use is largely replaced by vaping over a 10-year period. We test an Optimistic and a Pessimistic Scenario, differing in terms of the relative harms of e-cigarettes compared with cigarettes and the impact on overall initiation, cessation and switching. Projected mortality outcomes by age and sex under the Status Quo and E-Cigarette Substitution Scenarios are compared from 2016 to 2100 to determine public health impacts. Findings Compared with the Status Quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths with 86.7 million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6 million premature deaths are averted with 20.8 million fewer life years lost. The largest gains are among younger cohorts, with a 0.5 gain in average life expectancy projected for the age 15 years cohort in 2016. Conclusions The tobacco control community has been divided regarding the role of e-cigarettes in tobacco control. Our projections show that a strategy of replacing cigarette smoking with vaping would yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm.
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Affiliation(s)
- David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, District of Columbia, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Theodore R Holford
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Yuying Luo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
| | - David B Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
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25
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van Klaveren D, Wong JB, Kent DM, Steyerberg EW. Biases in Individualized Cost-effectiveness Analysis: Influence of Choices in Modeling Short-Term, Trial-Based, Mortality Risk Reduction and Post-Trial Life Expectancy. Med Decis Making 2017; 37:770-778. [PMID: 28854143 DOI: 10.1177/0272989x17696994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The benefits and costs of a treatment are typically heterogeneous across individual patients. Randomized clinical trials permit the examination of individualized treatment benefits over the trial horizon but extrapolation to lifetime horizon usually involves combining trial-based individualized estimates of short-term risk reduction with less detailed (less granular) population life tables. However, the underlying assumption of equal post-trial life expectancy for low- and high-risk patients of the same sex and age is unrealistic. We aimed to study the influence of unequal granularity between models of short-term risk reduction and life expectancy on individualized estimates of cost-effectiveness of aggressive thrombolysis for patients with an acute myocardial infarction. METHODS To estimate life years gained, we multiplied individualized estimates of short-term risk reduction either with less granular and with equally granular post-trial life expectancy estimates. Estimates of short-term risk reduction were obtained from GUSTO trial data (30,510 patients) using logistic regression analysis with treatment, sex, and age as predictor variables. Life expectancy estimates were derived from sex- and age-specific US life tables. RESULTS Based on sex- and age-specific, short-term risk reductions but average population life expectancy (less granularity), we found that aggressive thrombolysis was cost-effective (incremental cost-effectiveness ratio below $50,000) for women above age 49 y and men above age 53 y (92% and 69% of the population, respectively). Considering sex- and age-specific short-term mortality risk reduction and correspondingly sex- and age-specific life expectancy (equal granularity), aggressive thrombolysis was cost-effective for men above age 45 y and women above age 50 y (95% and 76% of the population, respectively). CONCLUSIONS Failure to model short-term risk reduction and life expectancy at an equal level of granularity may bias our estimates of individualized cost-effectiveness and misallocate resources.
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Affiliation(s)
- David van Klaveren
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands (DVK, EWS).,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (DVK, JBW, DMK)
| | - John B Wong
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (DVK, JBW, DMK).,Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA (JBW)
| | - David M Kent
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA (DVK, JBW, DMK)
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands (DVK, EWS)
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26
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Tam J, Warner KE, Meza R. Smoking and the Reduced Life Expectancy of Individuals With Serious Mental Illness. Am J Prev Med 2016; 51:958-966. [PMID: 27522471 DOI: 10.1016/j.amepre.2016.06.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/24/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION People with serious mental illness experience substantially reduced life expectancy, likely due in part to their higher smoking rates relative to the general population. However, the extent to which smoking affects their life expectancy, independent of mental illness, is unknown. This study quantifies the potential contribution of smoking to reduced life expectancy among individuals with serious psychological distress (SPD), a measure that screens for serious mental illness in national surveys. METHODS A cohort of 328,110 U.S. adults was examined using the 1997-2009 National Health Interview Surveys linked to the 2011 National Death Index. Cox models were used to estimate mortality hazard ratios for current smoking, former smoking, and SPD and construct life tables by smoking and SPD status. The smoking-attributable fraction of deaths by SPD status was calculated. Analyses were conducted in 2015. RESULTS Among those with SPD, being a current smoker doubles the risk of death. Current smokers with SPD lose 14.9 years of life relative to never smokers without SPD. Among never smokers, having SPD reduces life expectancy by 5.3 years. Thus, smoking may account for up to two thirds of the difference in life expectancy between smokers with SPD and never smokers without SPD. One third of deaths among those with SPD can be attributed to smoking. CONCLUSIONS The life expectancy difference between current smokers with SPD and never smokers without SPD is primarily due to smoking. Aiding individuals with serious mental illness to avoid smoking will translate into sizeable gains in life expectancy.
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Affiliation(s)
- Jamie Tam
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kenneth E Warner
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
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27
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Yang P, Wang Y, Wampfler JA, Xie D, Stoddard SM, She J, Midthun DE. Trends in Subpopulations at High Risk for Lung Cancer. J Thorac Oncol 2016; 11:194-202. [PMID: 26811226 DOI: 10.1016/j.jtho.2015.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Two-thirds of patients in the United States with newly diagnosed lung cancer would not meet the current U.S. Preventive Services Task Force (USPSTF) screening criteria, which suggests a need for amendment of the definition of high risk. To provide evidence of additional high-risk subpopulations and estimated gains and losses from using different criteria for screening eligibility, we conducted a two-step study using three cohorts. METHODS The two prospective cohorts comprised 5988 patients in whom primary lung cancer was diagnosed between 1997 and 2011 (the hospital cohort) and 850 defined-community residents (the community cohort); the retrospective cohort consisted of the population of Olmsted County, Minnesota, which was observed for 28 years (1984-2011). Subgroups of patients with lung cancer who might have been identified using additional determinates were estimated and compared between the community and hospital cohorts. The findings were supported by indirect comparative projections of two ratios: benefit to harm and cost to effectiveness. RESULTS Former cigarette smokers who had a smoking history of 30 or more pack-years and 15 to 30 quit-years and were 55 to 80 years old formed the largest subgroup not meeting the current screening criteria; they constituted 12% of the hospital cohort and 17% of community cohort. Using the expanded criteria suggested by our study may add 19% more CT examinations for detecting 16% more cases when compared with the USPSTF criteria. Meanwhile, the increases in false-positive results, overdiagnosis, and radiation-related lung cancer deaths are 0.6%, 0.1%, and 4.0%, respectively. CONCLUSIONS Current USPSTF screening criteria exclude many patients who are at high risk for development of lung cancer. Including individuals who are younger than 81 years, have a smoking history of 30 or more pack-years, and have quit for 15 to 30 years may significantly increase the number of cases of non-overdiagnosed screen-detected lung cancer, does not significantly add to the number of false-positive cases, and saves more lives with an acceptable amount of elevated exposure to radiation and cost.
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Affiliation(s)
- Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Yi Wang
- School of Environmental Science and Public Health, Wenzhou Medical University, Chashan University Town, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Yangpu District, Shanghai, People's Republic of China
| | - Shawn M Stoddard
- School of Environmental Science and Public Health, Wenzhou Medical University, Chashan University Town, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jun She
- Shanghai Respiratory Institute, Fudan University, No. 83 Wanghangdu Road, Jing'an District, Shanghai, People's Republic of China
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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28
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Méndez D, Tam J, Giovino GA, Tsodikov A, Warner KE. Has Smoking Cessation Increased? An Examination of the US Adult Smoking Cessation Rate 1990–2014. Nicotine Tob Res 2016; 19:1418-1424. [DOI: 10.1093/ntr/ntw239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/12/2016] [Indexed: 01/07/2023]
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Abstract
INTRODUCTION Lung cancer in never-smokers ranks among the 10 most common causes of death due to cancer worldwide and in the United States. However, it is unknown whether never-smokers at elevated risk for developing lung cancer may benefit from lung cancer screening. METHODS The MIcrosimulation SCreening ANalysis (MISCAN)-Lung microsimulation model was used to assess the effects of lung cancer screening for simulated cohorts of never-smokers at different levels of relative risk (RR) for lung cancer compared with never-smokers at average risk. The benefits and harms of screening were estimated for each cohort and compared with those of a cohort of ever-smokers eligible for lung cancer screening according to the United States Preventive Services Task Force (USPSTF) criteria. RESULTS The relative lung cancer mortality reduction in never-smokers was higher than the USPSTF eligible cohort (37% compared with 32%). However, the number of life-years gained per lung cancer death averted was lower (10.4 compared with 11.9) and the proportion of overdiagnosed cancers was higher (9.6% compared with 8.4%) for never-smokers compared with the USPSTF eligible cohort, as never-smokers are diagnosed at a later age. The estimated number of screens per lung cancer death averted ranged from 6162 for never-smokers at average risk to 151 for never-smokers with an RR of 35 compared with 353 for the USPSTF eligible cohort. CONCLUSIONS Never-smokers with RRs of 15 to 35 have similar to better trade-offs between benefits and harms compared with ever-smokers recommended for lung cancer screening by the USPSTF guidelines. For most never-smokers, lung cancer screening is not beneficial.
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30
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Yeh JM, Hur C, Ward Z, Schrag D, Goldie SJ. Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis. Gut 2016; 65:563-74. [PMID: 25779597 PMCID: PMC4573370 DOI: 10.1136/gutjnl-2014-308588] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/21/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of noncardia gastric adenocarcinoma (NCGA) screening strategies based on new biomarker and endoscopic technologies. DESIGN Using an intestinal-type NCGA microsimulation model, we evaluated the following one-time screening strategies for US men: (1) serum pepsinogen to detect gastric atrophy (with endoscopic follow-up of positive screen results), (2) endoscopic screening to detect dysplasia and asymptomatic cancer (with endoscopic mucosal resection (EMR) treatment for detected lesions) and (3) Helicobacter pylori screening and treatment. Screening performance, treatment effectiveness, cancer and cost data were based on published literature and databases. Subgroups included current, former and never smokers. Outcomes included lifetime cancer risk and incremental cost-effectiveness ratios (ICERs), expressed as cost per quality-adjusted-life-year (QALY) gained. RESULTS Screening the general population at age 50 years reduced the lifetime intestinal-type NCGA risk (0.24%) by 26.4% with serum pepsinogen screening, 21.2% with endoscopy and EMR and 0.2% with H. pylori screening/treatment. Targeting current smokers reduced the lifetime risk (0.35%) by 30.8%, 25.5%, and 0.1%, respectively. For all subgroups, serum pepsinogen screening was more effective and more cost-effective than all other strategies, although its ICER varied from $76,000/QALY (current smokers) to $105,400/QALY (general population). Results were sensitive to H. pylori prevalence, screen age and serum pepsinogen test sensitivity. Probabilistic sensitivity analysis found that at a $100,000/QALY willingness-to-pay threshold, the probability that serum pepsinogen screening was preferred was 0.97 for current smokers. CONCLUSIONS Although not warranted for the general population, targeting high-risk smokers for serum pepsinogen screening may be a cost-effective strategy to reduce intestinal-type NCGA mortality.
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Affiliation(s)
- Jennifer M. Yeh
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
| | - Chin Hur
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, USA
| | - Zachary Ward
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
| | - Deborah Schrag
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sue J. Goldie
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
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31
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Ten Haaf K, de Koning HJ. Overdiagnosis in lung cancer screening: why modelling is essential. J Epidemiol Community Health 2015; 69:1035-9. [PMID: 26071497 DOI: 10.1136/jech-2014-204079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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32
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Roth JA, Sullivan SD, Goulart BHL, Ravelo A, Sanderson JC, Ramsey SD. Projected Clinical, Resource Use, and Fiscal Impacts of Implementing Low-Dose Computed Tomography Lung Cancer Screening in Medicare. J Oncol Pract 2015; 11:267-72. [PMID: 25943596 DOI: 10.1200/jop.2014.002600] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years with ≥ 30-pack-year smoking history who currently smoke or quit in the last 15 years. The clinical, resource use, and fiscal impacts of this change in screening coverage policy remain uncertain. METHODS We developed a simulation model to forecast the 5-year health outcome impacts of the CMS low-dose CT screening policy in Medicare compared with no screening. The model used data from the National Lung Screening Trial, CMS enrollment statistics and reimbursement schedules, and peer-reviewed literature. Outcomes included counts of screening examinations, patient cases of lung cancer detected, stage distribution, and total and per-enrollee per-month fiscal impact. RESULTS Over 5 years, we project that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion ($2.22 per Medicare enrollee per month). The most fiscally impactful factors were the average cost-per-screening episode, proportion of enrollees eligible for screening, and cost of treating stage I lung cancer. CONCLUSION Low-dose CT screening is expected to increase lung cancer diagnoses, shift stage at diagnosis toward earlier stages, and substantially increase Medicare expenditures over a 5-year time horizon. These projections can inform planning efforts by Medicare administrators, contracted health care providers, and other stakeholders.
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Affiliation(s)
- Joshua A Roth
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
| | - Sean D Sullivan
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
| | - Bernardo H L Goulart
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
| | - Arliene Ravelo
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
| | - Joanna C Sanderson
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center; University of Washington, Seattle; VeriTech, Mercer Island, WA; and Genentech, South San Francisco, CA
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McMahon PM, Meza R, Plevritis SK, Black WC, Tammemagi CM, Erdogan A, ten Haaf K, Hazelton W, Holford TR, Jeon J, Clarke L, Kong CY, Choi SE, Munshi VN, Han SS, van Rosmalen J, Pinsky PF, Moolgavkar S, de Koning HJ, Feuer EJ. Comparing benefits from many possible computed tomography lung cancer screening programs: extrapolating from the National Lung Screening Trial using comparative modeling. PLoS One 2014; 9:e99978. [PMID: 24979231 PMCID: PMC4076275 DOI: 10.1371/journal.pone.0099978] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/21/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking. METHODS AND FINDINGS We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. 'Efficient' (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 'consensus efficient' (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient. CONCLUSIONS Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics.
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Affiliation(s)
- Pamela M. McMahon
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sylvia K. Plevritis
- Department of Radiology, Stanford University, Stanford, California, United States of America
| | - William C. Black
- Department of Radiology, Dartmouth Medical School, Hanover, New Hampshire, United States of America
| | | | - Ayca Erdogan
- Department of Radiology, Stanford University, Stanford, California, United States of America
| | - Kevin ten Haaf
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | - William Hazelton
- Program of Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Theodore R. Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jihyoun Jeon
- Department of Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Lauren Clarke
- Cornerstone Systems Northwest, Inc., Lynden, Washington, United States of America
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sung Eun Choi
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Vidit N. Munshi
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Summer S. Han
- Department of Radiology, Stanford University, Stanford, California, United States of America
| | | | - Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Suresh Moolgavkar
- Department of Epidemiology, School of Public Health University of Washington, Seattle, Washington, United States of America, and Department of Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | - Eric J. Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America
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Roth JA, Billings P, Ramsey SD, Dumanois R, Carlson JJ. Cost-effectiveness of a 14-gene risk score assay to target adjuvant chemotherapy in early stage non-squamous non-small cell lung cancer. Oncologist 2014; 19:466-76. [PMID: 24710309 DOI: 10.1634/theoncologist.2013-0357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Life Technologies has developed a 14-gene molecular assay that provides information about the risk of death in early stage non-squamous non-small cell lung cancer patients after surgery. The assay can be used to identify patients at highest risk of mortality, informing subsequent treatments. The objective of this study was to evaluate the cost-effectiveness of this novel assay. Patients and Methods. We developed a Markov model to estimate life expectancy, quality-adjusted life years (QALYs), and costs for testing versus standard care. Risk-group classification was based on assay-validation studies, and chemotherapy uptake was based on pre- and post-testing recommendations from a study of 58 physicians. We evaluated three chemotherapy-benefit scenarios: moderately predictive (base case), nonpredictive (i.e., the same benefit for each risk group), and strongly predictive. We calculated the incremental cost-effectiveness ratio (ICER) and performed one-way and probabilistic sensitivity analyses. Results. In the base case, testing and standard-care strategies resulted in 6.81 and 6.66 life years, 3.76 and 3.68 QALYs, and $122,400 and $118,800 in costs, respectively. The ICER was $23,200 per QALY (stage I: $29,200 per QALY; stage II: $12,200 per QALY). The ICER ranged from "dominant" to $92,100 per QALY in the strongly predictive and nonpredictive scenarios. The model was most sensitive to the proportion of high-risk patients receiving chemotherapy and the high-risk hazard ratio. The 14-gene risk score assay strategy was cost-effective in 68% of simulations. Conclusion. Our results suggest that the 14-gene risk score assay may be a cost-effective alternative to standard guideline-based adjuvant chemotherapy decision making in early stage non-small cell lung cancer.
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Affiliation(s)
- Joshua A Roth
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Group Health Research Institute, Group Health, Seattle, Washington, USA; Life Technologies Corporation, Carlsbad, California, USA; Department of Pharmacy, University of Washington, Seattle, Washington, USA
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de Koning HJ, Meza R, Plevritis SK, Haaf KT, Munshi VN, Jeon J, Erdogan SA, Kong CY, Han SS, van Rosmalen J, Choi SE, Pinsky PF, Berrington de Gonzalez A, Berg CD, Black WC, Tammemägi MC, Hazelton WD, Feuer EJ, McMahon PM. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160:311-20. [PMID: 24379002 PMCID: PMC4116741 DOI: 10.7326/m13-2316] [Citation(s) in RCA: 333] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The optimum screening policy for lung cancer is unknown. OBJECTIVE To identify efficient computed tomography (CT) screening scenarios in which relatively more lung cancer deaths are averted for fewer CT screening examinations. DESIGN Comparative modeling study using 5 independent models. DATA SOURCES The National Lung Screening Trial; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial; the Surveillance, Epidemiology, and End Results program; and the U.S. Smoking History Generator. TARGET POPULATION U.S. cohort born in 1950. TIME HORIZON Cohort followed from ages 45 to 90 years. PERSPECTIVE Societal. INTERVENTION 576 scenarios with varying eligibility criteria (age, pack-years of smoking, years since quitting) and screening intervals. OUTCOME MEASURES Benefits included lung cancer deaths averted or life-years gained. Harms included CT examinations, false-positive results (including those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related deaths. RESULTS OF BEST-CASE SCENARIO The most advantageous strategy was annual screening from ages 55 through 80 years for ever-smokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting. It would lead to 50% (model ranges, 45% to 54%) of cases of cancer being detected at an early stage (stage I/II), 575 screening examinations per lung cancer death averted, a 14% (range, 8.2% to 23.5%) reduction in lung cancer mortality, 497 lung cancer deaths averted, and 5250 life-years gained per the 100,000-member cohort. Harms would include 67,550 false-positive test results, 910 biopsies or surgeries for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of all cases of lung cancer [model ranges, 1.4% to 8.3%]). RESULTS OF SENSITIVITY ANALYSIS The number of cancer deaths averted for the scenario varied across models between 177 and 862; the number of overdiagnosed cases of cancer varied between 72 and 426. LIMITATIONS Scenarios assumed 100% screening adherence. Data derived from trials with short duration were extrapolated to lifetime follow-up. CONCLUSION Annual CT screening for lung cancer has a favorable benefit-harm ratio for individuals aged 55 through 80 years with 30 or more pack-years' exposure to smoking. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Harry J. de Koning
- Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, 1415 Washington Heights SPH-II 5533, Ann Arbor, Michigan 48109-2029, USA
| | - Sylvia K. Plevritis
- Director, NCI Stanford Center for Cancer Systems Biology. Stanford University, Department of Radiology, 1201 Welch Road, Room P060, MC 5488, Stanford, CA 94305-5488, USA
| | - Kevin ten Haaf
- Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Vidit N. Munshi
- MGH Institute for Technology Assessment, 101 Merrimac St., 3rd Floor, Boston, MA 02114-4724, USA
| | - Jihyoun Jeon
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA
| | - Saadet Ayca Erdogan
- Stanford University, Department of Radiology, 1201 Welch Road, Room P060, MC 5488, Stanford, CA 94305-5488, USA
| | - Chung Yin Kong
- Harvard Medical School, Mass. General Hospital Inst. for Tech. Assessment, 101 Merrimac St. 10th floor, Boston, MA 02114, USA
| | - Summer S. Han
- Stanford University, Department of Radiology, 1201 Welch Road, Room P060, MC 5488, Stanford, CA 94305-5488, USA
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Sung Eun Choi
- Harvard Medical School, Mass. General Hospital Inst. for Tech. Assessment, 101 Merrimac St. 10th floor, Boston, MA 02114, USA
| | - Paul F. Pinsky
- National Cancer Institute, National Institutes of Health, 6116 Executive Boulevard, Suite 504, Bethesda, Maryland 20892, USA
| | - Amy Berrington de Gonzalez
- National Cancer Institute, National Institutes of Health, 6116 Executive Boulevard, Suite 504, Bethesda, Maryland 20892, USA
| | - Christine D. Berg
- National Cancer Institute, National Institutes of Health, 6116 Executive Boulevard, Suite 504, Bethesda, Maryland 20892, USA
| | - William C. Black
- Dartmouth Hitchcock Medical Center, Dept Radiology, 1 Medical Center Drive Lebanon, NH 03756, USA
| | - Martin C. Tammemägi
- Brock University, Department of Community Health Sciences, Walker Complex - Academic South, Room 306, 500 Glenridge Avenue, St. Catharines, Ontario, Canada L2S 3A1
| | - William D. Hazelton
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA
| | - Eric J. Feuer
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 6116 Executive Boulevard, Suite 504, Bethesda, Maryland 20892, USA
| | - Pamela M. McMahon
- Harvard Medical School, Mass. General Hospital Inst. for Tech. Assessment, 101 Merrimac St. 10th floor, Boston, MA 02114, USA
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Meza R, ten Haaf K, Kong CY, Erdogan A, Black WC, Tammemagi MC, Choi SE, Jeon J, Han SS, Munshi V, van Rosmalen J, Pinsky P, McMahon PM, de Koning HJ, Feuer EJ, Hazelton WD, Plevritis SK. Comparative analysis of 5 lung cancer natural history and screening models that reproduce outcomes of the NLST and PLCO trials. Cancer 2014; 120:1713-24. [PMID: 24577803 DOI: 10.1002/cncr.28623] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography screening is an effective way of reducing lung cancer (LC) mortality. However, optimal screening strategies have not been determined to date and it is uncertain whether lighter smokers than those examined in the NLST may also benefit from screening. To address these questions, it is necessary to first develop LC natural history models that can reproduce NLST outcomes and simulate screening programs at the population level. METHODS Five independent LC screening models were developed using common inputs and calibration targets derived from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). Imputation of missing information regarding smoking, histology, and stage of disease for a small percentage of individuals and diagnosed LCs in both trials was performed. Models were calibrated to LC incidence, mortality, or both outcomes simultaneously. RESULTS Initially, all models were calibrated to the NLST and validated against PLCO. Models were found to validate well against individuals in PLCO who would have been eligible for the NLST. However, all models required further calibration to PLCO to adequately capture LC outcomes in PLCO never-smokers and light smokers. Final versions of all models produced incidence and mortality outcomes in the presence and absence of screening that were consistent with both trials. CONCLUSIONS The authors developed 5 distinct LC screening simulation models based on the evidence in the NLST and PLCO. The results of their analyses demonstrated that the NLST and PLCO have produced consistent results. The resulting models can be important tools to generate additional evidence to determine the effectiveness of lung cancer screening strategies using low-dose computed tomography.
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Affiliation(s)
- Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
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Holford TR, Levy DT, McKay LA, Clarke L, Racine B, Meza R, Land S, Jeon J, Feuer EJ. Patterns of birth cohort-specific smoking histories, 1965-2009. Am J Prev Med 2014; 46:e31-7. [PMID: 24439359 PMCID: PMC3951759 DOI: 10.1016/j.amepre.2013.10.022] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/01/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Characterizing the smoking patterns for different birth cohorts is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality, but the process of estimating birth cohort smoking histories has received limited attention. PURPOSE Smoking history summaries were estimated beginning with the 1890 birth cohort in order to provide fundamental parameters that can be used in studies of cigarette smoking intervention strategies. METHODS U.S. National Health Interview Surveys conducted from 1965 to 2009 were used to obtain cross-sectional information on current smoking behavior. Surveys that provided additional detail on history for smokers including age at initiation and cessation and smoking intensity were used to construct smoking histories for participants up to the date of survey. After incorporating survival differences by smoking status, age-period-cohort models with constrained natural splines were used to estimate the prevalence of current, former, and never smokers in cohorts beginning in 1890. This approach was then used to obtain yearly estimates of initiation, cessation, and smoking intensity for the age-specific distribution for each birth cohort. These rates were projected forward through 2050 based on recent trends. RESULTS This summary of smoking history shows clear trends by gender, cohort, and age over time. If current patterns persist, a slow decline in smoking prevalence is projected from 2010 through 2040. CONCLUSIONS A novel method of generating smoking histories has been applied to develop smoking histories that can be used in micro-simulation models, and has been incorporated in the National Cancer Institute's Smoking History Generator. These aggregate estimates developed by age, gender, and cohort will provide a complete source of smoking data over time.
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Affiliation(s)
- Theodore R Holford
- Department of Biostatistics (Holford, McKay), Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Cancer Control Department of Oncology (Levy), Washington DC
| | - Lisa A McKay
- Department of Biostatistics (Holford, McKay), Yale School of Public Health, New Haven, Connecticut
| | - Lauren Clarke
- Cornerstone Systems Northwest Inc. (Clarke, Racine), Lynden
| | - Ben Racine
- Cornerstone Systems Northwest Inc. (Clarke, Racine), Lynden
| | - Rafael Meza
- Department of Epidemiology (Meza), University of Michigan, Ann Arbor, Michigan
| | - Stephanie Land
- Division of Cancer Control and Population Sciences (Land, Feuer), National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Departments of Biostatistics and Biomathematics (Jeon), Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences (Land, Feuer), National Cancer Institute, Bethesda, Maryland
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Holford TR, Meza R, Warner KE, Meernik C, Jeon J, Moolgavkar SH, Levy DT. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964-2012. JAMA 2014; 311:164-71. [PMID: 24399555 PMCID: PMC4056770 DOI: 10.1001/jama.2013.285112] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE January 2014 marks the 50th anniversary of the first surgeon general's report on smoking and health. This seminal document inspired efforts by governments, nongovernmental organizations, and the private sector to reduce the toll of cigarette smoking through reduced initiation and increased cessation. OBJECTIVE To model reductions in smoking-related mortality associated with implementation of tobacco control since 1964. DESIGN, SETTING, AND PARTICIPANTS Smoking histories for individual birth cohorts that actually occurred and under likely scenarios had tobacco control never emerged were estimated. National mortality rates and mortality rate ratio estimates from analytical studies of the effect of smoking on mortality yielded death rates by smoking status. Actual smoking-related mortality from 1964 through 2012 was compared with estimated mortality under no tobacco control that included a likely scenario (primary counterfactual) and upper and lower bounds that would capture plausible alternatives. EXPOSURES National Health Interview Surveys yielded cigarette smoking histories for the US adult population in 1964-2012. MAIN OUTCOMES AND MEASURES Number of premature deaths avoided and years of life saved were primary outcomes. Change in life expectancy at age 40 years associated with change in cigarette smoking exposure constituted another measure of overall health outcomes. RESULTS In 1964-2012, an estimated 17.7 million deaths were related to smoking, an estimated 8.0 million (credible range [CR], 7.4-8.3 million, for the lower and upper tobacco control counterfactuals, respectively) fewer premature smoking-related deaths than what would have occurred under the alternatives and thus associated with tobacco control (5.3 million [CR, 4.8-5.5 million] men and 2.7 million [CR, 2.5-2.7 million] women). This resulted in an estimated 157 million years (CR, 139-165 million) of life saved, a mean of 19.6 years for each beneficiary (111 million [CR, 97-117 million] for men, 46 million [CR, 42-48 million] for women). During this time, estimated life expectancy at age 40 years increased 7.8 years for men and 5.4 years for women, of which tobacco control is associated with 2.3 years (CR, 1.8-2.5) (30% [CR, 23%-32%]) of the increase for men and 1.6 years (CR, 1.4-1.7) (29% [CR, 25%-32%]) for women. CONCLUSIONS AND RELEVANCE Tobacco control was estimated to be associated with avoidance of 8 million premature deaths and an estimated extended mean life span of 19 to 20 years. Although tobacco control represents an important public health achievement, efforts must continue to reduce the effect of smoking on the nation's death toll.
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Affiliation(s)
- Theodore R Holford
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Clare Meernik
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Jihyoun Jeon
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Suresh H Moolgavkar
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Yeh JM, Hur C, Schrag D, Kuntz KM, Ezzati M, Stout N, Ward Z, Goldie SJ. Contribution of H. pylori and smoking trends to US incidence of intestinal-type noncardia gastric adenocarcinoma: a microsimulation model. PLoS Med 2013; 10:e1001451. [PMID: 23700390 PMCID: PMC3660292 DOI: 10.1371/journal.pmed.1001451] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 04/05/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although gastric cancer has declined dramatically in the US, the disease remains the second leading cause of cancer mortality worldwide. A better understanding of reasons for the decline can provide important insights into effective preventive strategies. We sought to estimate the contribution of risk factor trends on past and future intestinal-type noncardia gastric adenocarcinoma (NCGA) incidence. METHODS AND FINDINGS We developed a population-based microsimulation model of intestinal-type NCGA and calibrated it to US epidemiologic data on precancerous lesions and cancer. The model explicitly incorporated the impact of Helicobacter pylori and smoking on disease natural history, for which birth cohort-specific trends were derived from the National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS). Between 1978 and 2008, the model estimated that intestinal-type NCGA incidence declined 60% from 11.0 to 4.4 per 100,000 men, <3% discrepancy from national statistics. H. pylori and smoking trends combined accounted for 47% (range = 30%-58%) of the observed decline. With no tobacco control, incidence would have declined only 56%, suggesting that lower smoking initiation and higher cessation rates observed after the 1960s accelerated the relative decline in cancer incidence by 7% (range = 0%-21%). With continued risk factor trends, incidence is projected to decline an additional 47% between 2008 and 2040, the majority of which will be attributable to H. pylori and smoking (81%; range = 61%-100%). Limitations include assuming all other risk factors influenced gastric carcinogenesis as one factor and restricting the analysis to men. CONCLUSIONS Trends in modifiable risk factors explain a significant proportion of the decline of intestinal-type NCGA incidence in the US, and are projected to continue. Although past tobacco control efforts have hastened the decline, full benefits will take decades to be realized, and further discouragement of smoking and reduction of H. pylori should be priorities for gastric cancer control efforts.
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Affiliation(s)
- Jennifer M Yeh
- Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, United States of America.
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Wang YC, Graubard BI, Rosenberg MA, Kuntz KM, Zauber AG, Kahle L, Schechter CB, Feuer EJ. Derivation of background mortality by smoking and obesity in cancer simulation models. Med Decis Making 2012; 33:176-97. [PMID: 23132901 DOI: 10.1177/0272989x12458725] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation models designed to evaluate cancer prevention strategies make assumptions on background mortality-the competing risk of death from causes other than the cancer being studied. Researchers often use the U.S. life tables and assume homogeneous other-cause mortality rates. However, this can lead to bias because common risk factors such as smoking and obesity also predispose individuals for deaths from other causes such as cardiovascular disease. METHODS We obtained calendar year-, age-, and sex-specific other-cause mortality rates by removing deaths due to a specific cancer from U.S. all-cause life tables. Prevalence across 12 risk factor groups (3 smoking [never, past, and current smoker] and 4 body mass index [BMI] categories [<25, 25-30, 30-35, 35+ kg/m(2)]) were estimated from national surveys (National Health and Nutrition Examination Surveys [NHANES] 1971-2004). Using NHANES linked mortality data, we estimated hazard ratios for death by BMI/smoking using a Poisson regression model. Finally, we combined these results to create 12 sets of BMI and smoking-specific other-cause life tables for U.S. adults aged 40 years and older that can be used in simulation models of lung, colorectal, or breast cancer. RESULTS We found substantial differences in background mortality when accounting for BMI and smoking. Ignoring the heterogeneity in background mortality in cancer simulation models can lead to underestimation of competing risk of deaths for higher-risk individuals (e.g., male, 60-year old, white obese smokers) by as high as 45%. CONCLUSION Not properly accounting for competing risks of death may introduce bias when using simulation modeling to evaluate population health strategies for prevention, screening, or treatment. Further research is warranted on how these biases may affect cancer-screening strategies targeted at high-risk individuals.
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Affiliation(s)
- Y Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, NY, USA (YCW)
| | | | - Marjorie A Rosenberg
- Departments of Actuarial Science, Risk Management and Insurance and Biostatics and Medical Informatics, University of Wisconsin–Madison, Madison, WI, USA (MAR)
| | - Karen M Kuntz
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA (KMK)
| | - Ann G Zauber
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA (AGZ)
| | | | | | - Eric J Feuer
- National Cancer Institute, Washington, DC, USA (BIG, EJF)
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McMahon PM, Hazelton WD, Kimmel M, Clarke LD. Chapter 13: CISNET lung models: comparison of model assumptions and model structures. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32 Suppl 1:S166-78. [PMID: 22882887 PMCID: PMC3478678 DOI: 10.1111/j.1539-6924.2011.01714.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Sophisticated modeling techniques can be powerful tools to help us understand the effects of cancer control interventions on population trends in cancer incidence and mortality. Readers of journal articles are, however, rarely supplied with modeling details. Six modeling groups collaborated as part of the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET) to investigate the contribution of U.S. tobacco-control efforts toward reducing lung cancer deaths over the period 1975-2000. The six models included in this monograph were developed independently and use distinct, complementary approaches toward modeling the natural history of lung cancer. The models used the same data for inputs, and agreed on the design of the analysis and the outcome measures. This article highlights aspects of the models that are most relevant to similarities of or differences between the results. Structured comparisons can increase the transparency of these complex models.
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Affiliation(s)
- Pamela M McMahon
- Institute of Technology Assessment, 101 Merrimac St., Boston, MA 02114-4724, USA.
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Hazelton WD, Jeon J, Meza R, Moolgavkar SH. Chapter 8: The FHCRC lung cancer model. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32 Suppl 1:S99-S116. [PMID: 22882896 PMCID: PMC3475418 DOI: 10.1111/j.1539-6924.2011.01681.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
As a member of the Cancer Intervention and Surveillance Modeling Network (CISNET), the lung cancer (LC) group at Fred Hutchinson Cancer Research Center (FHCRC) developed a model for evaluating U.S. lung cancer mortality trends and the impact of changing tobacco consumption. Model components include a biologically based two-stage clonal expansion (TSCE) model; a smoking simulator to generate smoking histories and other cause mortality; and adjustments for period and birth cohort to improve calibration to U.S. LC mortality. The TSCE model was first calibrated to five substantial cohorts: British doctors, American Cancer Society CPS-I and CPS-II, Health Professionals' Follow-Up Study (HPFS), and Nurses' Health Study (NHS). The NHS and HPFS cohorts included the most detailed smoking histories and were chosen to represent the effects of smoking on U.S. LC mortality. The calibrated TSCE model and smoking simulator were used to simulate U.S. LC mortality. Further adjustments were necessary to account for unknown factors. This provided excellent fits between simulated and observed U.S. LC mortality for ages 30-84 and calendar years 1975-2000. The FHCRC LC model may be used to study the effects of public health information on U.S. LC trends and the impact of tobacco control policy. For example, we estimated that over 500,000 males and 200,000 females avoided LC death between 1975 and 2000 due to increasing awareness since the mid 1950s of the harmful effects of smoking. We estimated that 1.1 million male and 0.6 million female LC deaths were avoidable if smokers quit smoking in 1965.
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Affiliation(s)
- William D. Hazelton
- Fred Hutchinson Cancer Research Center, Public Health Science Division, 1100 Fairview Avenue North, M2-B500 Seattle, WA 98109, USA
- To whom correspondence should be addressed: ,
| | - Jihyoun Jeon
- Fred Hutchinson Cancer Research Center, Public Health Science Division, 1100 Fairview Avenue North, M2-B500 Seattle, WA 98109, USA
| | - Rafael Meza
- Fred Hutchinson Cancer Research Center, Public Health Science Division, 1100 Fairview Avenue North, M2-B500 Seattle, WA 98109, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, 4647 SPH Tower, Ann Arbor, MI 48109, USA
| | - Suresh H. Moolgavkar
- Fred Hutchinson Cancer Research Center, Public Health Science Division, 1100 Fairview Avenue North, M2-B500 Seattle, WA 98109, USA
- To whom correspondence should be addressed: ,
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Feuer EJ, Levy DT, McCarthy WJ. Chapter 1:The impact of the reduction in tobacco smoking on U.S. lung cancer mortality, 1975-2000: an introduction to the problem. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32 Suppl 1:S6-S13. [PMID: 22882893 PMCID: PMC4688905 DOI: 10.1111/j.1539-6924.2011.01745.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
To better understand the contribution of cigarette smoking, and its changing role in lung cancer, this article provides an introduction to a special issue of Risk Analysis, which considers the relationship between smoking and lung cancer death rates during the period 1975-2000 for U.S. men and women aged 30-84 years. Six models are employed, which are part of a consortium of lung cancer modelers funded by National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET). Starting with birth-cohort-specific smoking histories derived from National Health Interview Surveys, three scenarios are modeled: Actual Tobacco Control (observed trends in smoking), Complete Tobacco Control (a counterfactual lower bound on smoking rates that could have been achieved had all smoking ceased after the first Surgeon General's report in 1964), and No Tobacco Control (a counterfactual upper bound on smoking rates if smoking patterns that prevailed before the first studies in the 1950s began to inform the public about the hazards of smoking). Using these three scenarios and the lung cancer models, the number and percentage of lung cancer deaths averted from 1975-2000, among all deaths that could have been averted if tobacco control efforts been immediate and perfect, can be estimated. The variability of the results across multiple models provides a measure of the robustness of the results to model assumptions and structure. The results provide not only a portrait of the achieved impact of tobacco control on lung cancer mortality, but also the bounds of what still needs to be achieved.
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Affiliation(s)
- Eric J Feuer
- Statistical Methodology and Applications Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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McMahon PM, Kong CY, Johnson BE, Weinstein MC, Weeks JC, Tramontano AC, Cipriano LE, Bouzan C, Gazelle GS. Chapter 9: The MGH-HMS lung cancer policy model: tobacco control versus screening. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32 Suppl 1:S117-24. [PMID: 22882882 PMCID: PMC3478757 DOI: 10.1111/j.1539-6924.2011.01652.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The natural history model underlying the MGH Lung Cancer Policy Model (LCPM) does not include the two-stage clonal expansion model employed in other CISNET lung models. We used the LCPM to predict numbers of U.S. lung cancer deaths for ages 30-84 between 1975 and 2000 under four scenarios as part of the comparative modeling analysis described in this issue. The LCPM is a comprehensive microsimulation model of lung cancer development, progression, detection, treatment, and survival. Individual-level patient histories are aggregated to estimate cohort or population-level outcomes. Lung cancer states are defined according to underlying disease variables, test results, and clinical events. By simulating detailed clinical procedures, the LCPM can predict benefits and harms attributable to a variety of patient management practices, including annual screening programs. Under the scenario of observed smoking patterns, predicted numbers of deaths from the calibrated LCPM were within 2% of observed over all years (1975-2000). The LCPM estimated that historical tobacco control policies achieved 28.6% (25.2% in men, 30.5% in women) of the potential reduction in U.S. lung cancer deaths had smoking had been eliminated entirely. The hypothetical adoption in 1975 of annual helical CT screening of all persons aged 55-74 with at least 30 pack-years of cigarette exposure to historical tobacco control would have yielded a proportion realized of 39.0% (42.0% in men, 33.3% in women). The adoption of annual screening would have prevented less than half as many lung cancer deaths as the elimination of cigarette smoking.
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Affiliation(s)
- Pamela M McMahon
- Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA 02114, USA.
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Jeon J, Meza R, Krapcho M, Clarke LD, Byrne J, Levy DT. Chapter 5: Actual and counterfactual smoking prevalence rates in the U.S. population via microsimulation. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2012; 32 Suppl 1:S51-68. [PMID: 22882892 PMCID: PMC3478148 DOI: 10.1111/j.1539-6924.2011.01775.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The smoking history generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As an example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975-2000.
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Affiliation(s)
- Jihyoun Jeon
- Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
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